INTRADIJALIZNA HIPOTENZIJA: KLINIČKE POSLEDICE I OSNOVNI PRINCIPI PREVENCIJE
Sažetak
Intradijalizna hipotenzija je faktor rizika za nepovoljan ishod bolesnika koji se leče redovnom hemodijalizom. Hemodinamska nestabilnost u roku seanse hemodijalize za posledicu ima ishemiju/reperfuziju miokarda i mozga. Ponovljene epizode ishemije I reperfuzije mikarda i mozga za posledicu imaju ošamućenje miokarda i oštećenje mozga (atrofija subkortikalne bele mase). Ošamućenje miokrda uzrokuje poremećaj regionalne pokretljivosti zida leve komore i razvoj sistolne srčane slabosti, a oštećenje mozga poremećaj kognicije. Prevencija razvoja intradijalizne hipotenzije treba da uključi restrikciju unosa soli, interdijalizni prinos u telesnoj masi bolesnika manji od 5%, stopu ultrafiltracije manju od 10 ml/kg/h, podešavanje koncentracije natrijuma i kalcijuma u rastvoru za hemodijalizu, hladan rastvor za hemodijalizu (35-370C), primenu vazopresora, hemodijafiltracije i novih modaliteta dijalize u čijoj osnovi su biofeedback sistemi. Očuvanje hemodinamske stabilnosti bolesnika u toku seanse hemodijalize je primarni cilj nefrologa.
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