Hemodiyaliz Hastalarında Ambulatuvar Ölçümlerdeki Kan Basıncı Değişkenliği ve Etki Eden Faktörler

Abstract

Recently researches showed that, elevated blood pressure variability (BPV) is associated with cardiovascular and general mortality, independent of mean blood pressure levels. The pathophysiology of BPV likely relates to sympathetic nervous system, humoral factors and arterial compliance. We aimed to evaluate the BPV in hemodialysis patients by during and 24-h after hemodialysis ambulatory blood pressure monitoring (ABPM). Among the 56 chronic hemodialysis patients (28 males, 28 females) participating in the study, 44.6% had diabetes mellitus (DM) and 46.4% had coronary artery disease (CAD). Mean blood pressure and BPV were lowest at intradialytic measurements and highest at 12-24 hour after dialysis. Intradialytic systolic, 24-h systolic and 24-h diastolic blood pressure were correlated with BPV. Intradialytic and 24-h systolic and diastolic BPV (SBPV, DBPV) were higher in those with DM, than without DM (p<0,05). Intradialytic and daytime SBPV were higher with the patients who had CAD, than others (p<0,05). 24-h SBPV, nighttime SBPV and intradialytic DBPV were higher with the patients interdialytic weight gain higher than %3, compared to others. 24-h, night-time and first 12 hours after dialysis SBPV were higher with the patients with intradialytic hypotension, compared to others. Nighttime SBPV and DBPV and 12 hours after dialysis DBPV were lower on those patients receiving regimens calcium channel blocker-based regimens, whereas patients receiving β-blocker–based regimens (p<0,05). 24-h and nighttime DBPV were higher with those patients CaxP product higher than median value compared to others. Night-time SBPV was related with hemodialysis vintage, vascular access type and ultrafiltration rate. In conclusion, hemodialysis related features (calcium-phosphor balance, volume status, dialysis vintage), drugs and comorbidities (CAD, DM) are associated with blood pressure variability.