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