Author/Editor		Zbačnik, Rok; Gregorič, Gašper
Title		48-urno neinvazivno ambulantno merjenje krvnega tlaka pri bolnikih s končno ledvično odpovedjo, zdravljenih s pomočjo hemodialize
Translated title		48-hour non-invasive ambulatory blood pressure monitoring in patients with end stage renal failure, treated by haemodialysis
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 37, št. 3
Publication year		1998
Volume		str. 323-37
Language		slo
Abstract		The purpose of this prospective study was to determine the potential effects of various factors on blood pressure (BP) levels in 40 patients treated by haaemodialysis. A 48-hour non-invasive ambulatory BP monitoring was used because it allows for the evaluation of BP values and its dynamics outside the hospital setting. The study showed BP was not affected by sex, age, years on dialysis, interdialytic weight gain and starting hour of the haemodialysis treatment (p > 0,05). The erythropoetin therapy resulted in higher systolic and dyastolic BPs (p = 0.03 and p = 0.008, respectively). Haemodialysis patients on antihypertensive therapy had higher systolic BPs than those recie- ving no therapy (p = 0.035), which suggested that the control of hypertension was inadequate despite the use of antihypertonic drugs. Patients treated by acetatefree dialysis method had lower diurnal nocturnal mean dyastolic BPs than those treated by a conventional bicarbona- te method (p = 0.008 and p = 0.0016, respectively). No difference in mean BPs was found between patients treated by bicarbonate, acetate and haemo(dia)filtration haemodialysis method. Systolic BPs were significantly lower during a 5-hour period on the non-dialysis day than during the dialysis session (p < 0.015). These results confirmed the influence of the stressful hospital environment on BP and indicated the inadequacy of BP values measured at the beginning of haemodyalisis for an objective evaluuation ofhypertension control. We think that an objective evaluation of BP levels in patients treated by chronic haemodyalisis for end stage renal failure a regular 48-hour non-invasive ambulatory BP monitoring should be used at least once a year.
Summary		S prospektivno raziskavo smo z 48-urnim neinvazvnim ambulantnim merjenjem krvnega tlaka (KT) ugotavljali gibanje KT in vpliv različnih dejavnikov na KT pri 40 hemodializnih bolnikih. Objektivno smo ugotavljali gibanje KT tudi izven bolnišnice. Rezultati raziskave so pokazali, da spol, starost, pridobljena telesna teža v času med dvema hemodializama in ura začetka hemodializnega postopka niso imeli pomembnega vpliva na KT (p > 0,05). Bolniki, ki prejemajo eritropoetin, so imeli vižja sistolični in diastolični KT (p = 0,03 in p = 0,008). Bolniki, zdravljeni s hemodializo in ukrepi proti zvišanemu krvnemu tlaku, so imeli višji sistolični KT (p = 0,035) kot bolniki brez zdravljenja, kar kaže, da KT kljub zdravljenju ni normalen. Bolniki, zdravljeni z brezacetatno hemodializno metodo, so imeli nišja dnevna in nočna povprečja diastoličnega KT kot bolniki na bikarbonatni hemodializni metodi (p = 0,008 in p = 0,0016). Med bolniki, zdravljenimi z bikarbonatno, acetatno in hemo(dia)filtracijsko metodo nismo ugo- tovili razlik v urejenosti KT. Ugotovili smo značilno nižji sistolični KT v obdobju petih ur nedializnega dne (24 ur po dializi) v primerjavi z vrednostmi tlaka med dializnim postopkom (p < 0,015). Iz ugotovitve sklepamo na velik pomen stresnega okolja bolnišnice na vrednosti KT in neprimernost izmerjenega KT v začetku dialize za oceno urejenosti KT. Menimo, da je 48 urno neinvazivno ambulantno merjenje KT potrebno uvrstiti med redne, najmanj enkrat letne preiskave bolnikov s končno odpovedjo ledvic, zdravljenih s kronično hemodializo.
Descriptors		KIDNEY FAILURE, CHRONIC BLOOD PRESSURE MONITORING, AMBULATORY HEMODIALYSIS HYPERTENSION ERYTHROPOIETIN