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Hemodiyaliz Hipotansiyonu Olan Hastalarda Otonomik Disfonksiyonun Tanı ve Tedavisindeki Yenilikler

Up-to-date in Diagnosis and Treatment on Autonomic Dysfunction in Patients With Hemodialysis Hypotension

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2004
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Abstract (Original Language): 
Diyalize bağlı hipotansiyon (DBH), diyaliz tedavi seanslarının %15-30'unda rastlanan hemodiyalizin en sık görülen komplikasyonudur (1). DBH oluşumundaki majör faktör diyaliz işlemi sırasında sıvının agresif ultrafiltrasyonudur (UF) (2). UF ve solid maddelerin geçişi ile ekstrasellüler osmolalitenin azalması plazma vo-lümünde dramatik bir azalmaya sebep olur (2). Hipo¬tansiyon oluştuğunda volüm azalması, venöz dönüşün azalması ve arteriyoler vazokonstriksiyon ile sonuçla¬nır. Çoğu diyaliz hastasında vasküleritedeki normal fizyolojik cevapla kompansatuar olarak volüm deplesyo-nunda düzelme olur. Hastaların bir subgrubunda ise semptomatik DBH, hemodiyaliz seanslarının %50'den fazlasında görülmektedir (3,4). Hemodiyaliz tedavisi şu anda dünyada akut ve kro¬nik böbrek yetmezliği olan 1 milyon hastada kullanıl¬maktadır. Amerika Birleşik Devletleri'nde 210 000'den fazla hasta hemodiyaliz merkezlerine gitmekte olup, 1996 yılında bu hastaların %96.4'ü haftada 3 kez diyaliz tedavisi almaktadır (5-7). Hemodiyaliz tedavi seanslarının %15-30'unda gelişen DBH; hemodiyaliz sırasında kan basınçlarında 30 mmHg ve daha fazla düşüş ya da diyaliz öncesi sis-tolik kan basıncı 100 mmHg ve altında olan hastalar- da 30 mmHg'ya kadar olan düşüş ile karakterizedir (1,6,8). DBH sadece sıklığı nedeni ile değil, ayrıca diyaliz hastasının kendini kötü hissetmesi ile rehabilitasyonu¬nu kısıtlaması ve diyaliz personelinin gereksiz yere za¬man ve malzeme kaybına neden olması ile de önemli¬dir (5). Son dönem böbrek yetmezliği (SDBY) olan hastalarda gelişen DBH, hemodiyaliz tedavisi gören hastala¬rın önemli bir morbidite ve mortalite nedenidir (1-4). Hemodiyaliz ünitelerinde, kan basıncında şiddetli ve çok hızlı düşüş gösteren hastalarla çok sık karşılaşıl¬maktadır. Bu hipotansif ataklarda, ek olarak; kas krampları, bulantı, kusma, baş dönmesi, şiddetli yor¬gunluk, halsizlik, esneme hareketleri gibi morbiditeyi artıran durumlar sık görülmektedir. Bu semptomlar dı¬şında daha şiddetli ve hayatı tehdit eden, mortaliteyi ar¬tıran problemler de vardır. Bunlardan serebrovasküler yetmezlik (geçici iskemik atak), serebrovasküler olay, senkop atakları, kardiyovasküler düzensizlik (miyokard iskemisi ve aritmiler) gelişimi mortaliteyi artıran önem¬li DBH komplikasyonlarıdır (1-4,9,10).
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138
Türk
Nefroloj
i Diyaliz ve Transplantasyon Dergisi /Official Journal of the Turkish Society of Nephrology
Hemodiyaliz Hipotansiyonu Olan Hastalarda Otonomik Disfonksiyonun Tanı ve Tedavisindeki Yenilikler
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