ارتباط بين سديم مايع دياليز و فشار خون در بيماران مبتلا به نارسايي مزمن كليه

The evaluation Of relationship between blood pressure and dialysate Na concentration in chronic hemodialysis patient

مقدمه عوارض كارديووسكولار شايع ترين علت مرگ بيماران دياليزي مزمن مي باشد، كه فشار خون يكي از فاكتورهاي مهم آن است. يكي از مسائلي كه جهت كنترل فشار خون در بيماران دياليزي مطرح شده است مقدار سديم مايع دياليز است. روش كار اين مطالعه به صورت مقطعي-مشاهده اي در سال 93 بر 266 نفر از بيماران دياليزي در مركز درماني لقمان حكيم، اشرفي اصفهاني و غرب تهران كه به دلايل مختلف ESRD شده اند، انجام شده است و به مدت يك ماه فشار هاي سيستولي قبل و بعد از دياليز و سديم مايع دياليز بيماران اندازه گيري شد. در پايان يك ماه ميانگين تمام داده هاي هر بيمار توسط برنامه SPSS بررسي شد. نتايج فشار خون بعد دياليز با فشار خون قبل دياليز تفاوت معني داري داشته است (0/001>p) و ضريب همبستگي پيرسون بين SBPΔ با سديم مايع دياليز و سرعت پمپ دستگاه از نظر آماري معني دار بودند. براي تعيين معادله رگرسيون جهت پيش بيني فشار خون بعد دياليز از رگرسيون خطي چند متغيره به روش Back ward استفاده شد كه به قرار زير است.SBP after – SBP before = -41/5 + 0/11(sodium of dialysate) – 0/3(speed of pomp) نتيجه گيري تغييرات فشار خون قبل و بعد از دياليز به صورت معني داري با تغييرات سديم مايع دياليز ارتباط دارد و اين رابطه مستقل از بقيه عوامل موثر بر فشار خون و هم جهت مي باشد.

Introduction: Cardiovascular complications are the most common Cause of death in ESRD patients. Hypertension is one of the traditional risk factors of CVD. The Aim of this study was to investigate the association between Concentration of Na dialysate and blood pressure in chronic hemodialysis patients. Material & Methods: This cross sectional study was performed on 266 adult patients undergoing of hemodialysis at least for 3 months. Pre HD systolic BP and post HD systolic BP during 4 weeks were measured in relation to Na dialysate concentration. The other main factors affecting the post-dialysis blood pressure, such as Body Mass Index (BMI), pump speed, dialysis solution temperature, duration of dialysis and intradialysis weight gain (IDWG) were considered. Mean of ΔSBP (post HD sys BP - pre HD sys BP) in each patient in 12 sessions of HD was measured and statistically analyzed in relation to dialysate Na with SPSS 21. Backward multivariable linear regression analysis and Pearson correlation coefficients were used to evaluate the correlation between sodium gradient and ΔSBP. Results: Systolic blood pressure was significantly changed before and after dialysis in relation to dialysate Na (p <0.001). The analysis was stepwise multivariable linear regression. Those variables with significant values, such as dialysate Na concentration and blood flow rate (pump speed) remained in final step. The person’s correlations between ΔSBP with dialysate sodium and blood flow rate (pump speed) were statistically significant (p<0.01). Conclusion: We Found that changes in systolic blood pressure before and after dialysis significantly associated with dialysate sodium concentration.