REGULACIJA KRVNOG TLAKA U BOLESNIKA NA DIJALIZI

PETAR KES, NIKOLINA BAŠIĆ-JUKIĆ, IVANA JURIĆ, BRUNA BRUNETTA

Do 90% bolesnika na hemodijalizi (HD) ima krvni tlak viši od 140/90 mmHg, što donosi rizik od razvoja srčanožilnih bolesti i visoku smrtnost. Cilj liječenja hipertenzije u HD bolesnika je normaliziranje krvnog tlaka. Najvažniju ulogu u regulaciji krvnog tlaka kod bolesnika na HD ima regulacija volumena tekućina, ali nisu zanemarivi ni drugi čimbenici kao što su aktivacija simpatičkog živčanog sustava i poremećena vazodilatacija s posljedičnim promjenama žilnog otpora, sekundarni hiperparatiroidizam i njegovi učinci na ravnotežu kalcija i kontraktilnost glatkih mišićnih stanica krvnih žila, korekcija bubrežne anemije primjenom eritropoetina, regulacija unosa soli, učestalost i trajanje postupaka hemodijalize. Za postizanje normotenzije ključna je uspostava ravnoteže vode i elektrolita uz pomoć HD, a antihipertenzivna terapija obično je od sekundarnog značenja.

Summary. Up to 90% of chronic haemodialysis patients have blood preasure (BP) greater than 140/90 mmHg. This suggests that only a minor number of the haemodialysis patients have adequate BP control. This is associated with signifi- cantly increased morbidity and mortality in haemodialysis population when compared with normal, healthy population. The main aim of antihypertensive treatment in hypertensive haemodialysis patients is to achieve BP values which should not differ from those recommended for general population. The most important factor in BP regulation in haemodialysis patients is adequate fluid volume regulation. Sympathetic nervous system and impaired vasodilatation with consequent changes in peripheral vascular resistance, secondary hyperparathyreoidism and its effects on calcium balance and consequent effects on cotractility of the smooth muscle cells of the vessel wall, correction of renal anemia in patients receiving human recombinant erythropoietin, regulation of salt intake, and frequency and duration of haemodialysis procedure have also a significant role in BP regulation in these patients. If dialysis procedure is not adequate, meaning that salt and water balance is not satisfyng, antihypertensive medications cannot alone control BP in haemodialysis patients.