Фактори ризика за развој кардиоваскуларних болести код болесника који се лече хемодијализом

  • Marko S Ilić Opšta bolnica Ćuprija, Služba hemodijalize i endemske nefropatije

Sažetak


Kardiovaskularne bolesti su vodeći uzrok smrti kod bolesnika koji se leče hemodijalizom. Kod ovih bolesnika prisutni su različiti tradicionalni i netradicionalni faktori rizika za razvoj kardiovaskularnih bolesti. U tradicionalne faktore rizika spadaju arterijska hipertenzija , hiperlipidemija, šećerna bolest, gojaznost, pušenje cigareta i smanjena fizička aktivnost. U netradicionalne faktore rizika spadaju mikroinflamacija, hiperhomocisteinemija, oksidativni stres, malnutricija, sekundarni hiperpratireoidizam, anemija, retencija natrijuma i vode i povećan protok krvi kroz vaskularni pristup za hemodijalizu. U ovom preglednom radu detaljnije su opisani uzroci nastanka, načini dijagnostikovanja  i lečenja za tri glavna faktora rizika a to su arterijska hipertenzija, šećerna bolest i hiperlipidemija kao i za sve  netradicionalne faktore rizika za razvoj kardiovaskularnih bolesti kod bolesnika koji se leče hemodijalizom.

Ključne reči: hemodijaliza; kardiovaskularne bolesti; faktori rizika; lečenje.

Biografija autora

Marko S Ilić, Opšta bolnica Ćuprija, Služba hemodijalize i endemske nefropatije

Šef službe hemodijalize i endemske nefropatije

Specijalista interne medicine

Reference

Petrovic D, Stojimirović B. Cardiovascular morbidity and mortality in hemodialysis patients – epidemiological analysis. Vojnosanit Pregl 2008; 65(12): 893-900.

Johnson DW, Craven AM, Isbel NM. Modification of cardiovascular risc in hemodialysis patients: An evidence – based eview. Hemodialysis Int 2007; 11(1): 1-14.

Locatelli F, Covic A, Chazot C, Leunissen K, Luno J, Yaqoob M, et al.Hypertension and cardiovascular risc assesment in dialysis patients. Nephrol Dial Transplant 2004;19(5)1058-68

Chen J, Gul A, Sarnak MJ. Menagement of Intradialytic Hypertension: The Ongoing Challenge. Semin Dial 2006; 19(2): 141-5.

Vaziri ND, Moradi H. Mechanism of dyslipidemia of chronic renal failure. Hemodialysis Int 2006; 10(1): 1-7.

Petrović D, Nikolić A, Stojimirović B. Poremećaj metabolizma lipida u hroničnoj slabosti bubrega: dijagnostika i lečenje. Medicinski časopis 2009; 43(1): 21-7.

National Kidney Foundation. Clinical practice guidelines for managing dyslipidemias in chronic kidney disease. Am J Kidney Dis 2003; 41(4 Suppl 3): 1-91.

Knopp RH. Drug Treatment of Lipid Disorders. N Engl J Med 1999; 341(7): 498-511.

Petrović D, Bajović LJ, Jovanović M,Poskurica M. Dijabetesna nefropatija – dijagnostika i lečenje. Medicus 2001; 2(1): 10-4.

Jensen SJ, Clausen P, Borh-Johnsen k. Detecting microalbuminuria by urinary albumin/creatinine concentration ratio. Nephol Dial Transplant 1997; 12(Suppl 2): 6-9.

Hovind P, Rossing P, Tarnow L, Smidt UM, Paraving H-H. Progresion of diabetic nephropathy. Kidney Int 2001; 59(2): 702-9.

Abbate M, Remuzzi G. Proteinurija as a Mediator of Tubulointerstitial Injury. Kidney Blood Press Res 1999; 22(1-2): 37-46.

Petrović D, Nikolić A, Stojimirović B. Klinički značaj kontrole faktora rizika u sprečavanju progresije dijabetesne nefropatije. Medicinski časopis 2010; 44(1): 19-27.

Bennet PH, Haffner S, Kasike BL, Keane WF, Morgensen CE, Parving H-H, et al. Screening and Menagement of Microalbuminuria in Patients With Diabetes Mellitus: Recommendations to the Scientific Advisory Board of the National Kidney Foundation From an Ad Hpc Commitee of the Council on Diabetes Mellitus of the National Kidney Foundation. Am J Kidney Dis 1995; 25(1): 107-12.

Stenvinkel P. Inflamation in end-stage renal disease: The hidden enemy. Nephrology 2006; 11(1):36-41.

Ward RA. Ultrapure Dialysate. Semin Dial 2004; 17(6): 489-97.

Wanner C, Zimmermann J, Schwedeler S, Metzger T. Inflammation and cardiovascular risc in dialysis patiens. Kidney Int 2002; 61(Suppl 80): 99-102.

Galle J, Seibold S, Wanner C. Inflammation in Uremic Patiens:What Is the Link? Kidney Blood Press Res 2003; 26(2):65-75.

European Best Practice Guidelines for the menagement of Anaemia in patients with Chronic Renal Failure. Nephrol Dial Transplant 1999; 14(Suppl 5): 2-32.

Cavill I. Iron and erithropoietin in renal disease. Nephrol Dial Transplant 2002; 17(Suppl 5): 19-23.

National Kidney Foundation K/DOQI. Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: Update 2000. Am J Kidney Dis 2001; 37(Suppl 1): 182-238.

Stojimirović B, Petrović D. Klinički značajkontrole faktora rizika u sprečavanju progresije hronične slabosti bubrega. Vojnosanit.Pregl 2006; 63(6): 585-91.

Locatelli F, Canaud B, Eckardt K-U, Stenvinkel P, Wanner C,Zocalli C. Oxidative stress in end-stage renal disease: an emerging threat to patient autcome, Nephrol Dial Transplant 2003; 18(7):1277-80.

Rohrmoser MM, Mayer G. Reactive Oxygen Species and Glomerular Injury. Kidney Blood Press Res 1996; 19(5): 263-9.

Gwinner W, Grone H-J. Role of reactive oxygen species in glomerulonephritis . Nephrol Dial Transplant 2000; 15(8): 1127-32.

Descamps-Latscha B, Drueke T, Witko-Sarast V. Dialysis-Induced Oxidative stress: Biological Aspects,Clinical Consequences and Therapy. Semin Dial 2001; 14(3): 793-9.

Friedman AN, Bostom AG, Selhub J, Levey AS, Rosenberg IH. The Kidney and Homocysteine Metabolism. J Am Soc Nephrol 2001; 12(12): 2181-9.

Petrovic D, Stojimirović B. Homocistein – faktor rizika za razvoj kardiovaskularnih komplikacija kod bolesnika na hemodijalizi. U: Kardionefrologija 2. Radenković S, (ed).GIP“PUNTA“. Niš. 2005: 31-6.

Zocalli C, Bode-Boger SM, Mallamaci F, Benedetto FA, Tripepi G, Malatino LS, et al.Plasma concentration of asymetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study. Lancet 2001; 358(9299): 2113-7.

Boger RH. The emerging role of asimmetric dimethylarginine as a novel cardiovascular risc factor. Cardiovasc Res 2003; 59(4): 824-33.

Kalantar-Zadeh K, Ikizler TA, Avram MM, Kopple JD. Malnutrition-inflammation complex syndrome in dialysis patients: Causes and cosequences. Am J Kidney Dis 2003; 42(5): 864-8.

Petrović D, Stojimirović B. Sekundarni hiperparatireoidizam-faktor rizika za razvoj kardiovaskularnih komplikacija kod bolesnika na hemodijalizi. Med Pregl 2010;LXIII(9-10): 674-80.

Gutierrez O, Isakova T, Rhee E et al. Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. J Am Soc Nephrol 2005; 16: 2205–2215.

Juppner H. Phosphate and FGF-23. Kidney Int 2011; 79 (Suppl 121): S24–S27.

Cannata-Andia JB, Carrera F. The Pathophysiology of Secondary Hyperparathyroidism and the Cosequences of Uncontrolled Mineral Metabolism in Chronic Kidney Disease: The Role od COSMOS. Nephrol Dial Transplant 2008; 1(Suppl 1): 29-35.

Goodman WG. The Conequences of Uncontrolled Secondary Hyperparathyroidism and its Treatment ij Chronic Kidney Disease. Semin Dial 2004;17(3):209-216.

National Kidney Foundation. Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease.Am J Kidney Dis 2003; 42(4 Suppl 3): 1-201.

Goodman WG. Medical menagement of secondary hyperparathyroidism in chronic renal failure. Nephrol Dial Transplant 2003; 18(Suppl 3): 2-8.

De Francisco ALM, Carrera F. A new paradigm for treatment of secondary hyperparathyroidism. NDT Plus 2008; 1(Suppl 1): 24-8.

Petrović D, Stojimirović B. Protok krvi kroz vaskularni pristup za hemodijalizu – faktor rizika za razvoj kardiovaskularnih komplikacija kod bolesnika na hemodijalizi. Med Pregl 2007; LX(3-4): 183-6.

Mac Rae JM, Levin A, Belenkie I. The Cardiovascular Effects of Arteriovenous Fistulas in Chronic Kidney Disease: A Couse for Concern? Semin Dial 2006; 19(5): 349-52.

Allon M. Current Menagement of Vascular Access. Clin J Am Soc Nephrol 2007; 2(4):786-800.

NFK-K/DOQI clinical practice guidelines for vascularaccess: Update 2000. Am J Kidney Dis 2001; 37(1 Suppl 1): 137-181.

Lopez-Gomez JM, Villaverde M, Jojfre R, et al. Interdialytic weight gain as a marker of bloo pressure, nutrition and survival in hemodialysis patients. Kidney Int 2005; 67(Suppl 93): 63-8.

London GM, Guerin AP, Marchais SJ. Hemodynamic Overload in End-Stage Renal Disease Patients. Semin Dial 1999; 12(2): 77-83.

Objavljeno
2020/10/25
Rubrika
Seminar