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2020, vol. 77, br. 1, str. 60-69
Uticaj aktivne kontrole volemije na srčanu hemodinamiku i mehaniku kod bolesnika na hroničnom lečenju hemodijalizom
aSpecial Hospital for Hemodialysis 'Fresenius Medical Care', Belgrade
bKliničko-bolnički centar Zvezdara, Beograd
cUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd

e-adresazoran.paunic@gmail.com
Sažetak
Uvod/Cilj. Hipervolemija i nedostaci kliničkog procenjivanja tzv. "suve težine" kod bolesnika na lečenju hemodijalizom (HD) su dobro poznati faktori rizika za visok kardiovaskularni morbiditet i mortalitet ove populacije. Metode. Sprovedena je unicentrična randomizirana prospektivna studija da bi se ispitala moguc'a korist primene aktivne kontrole volemije (AKV), a na osnovu njenog merenja bioimpedantnom spektroskopijom (BIS), na srčanu morfologiju i funkciju i na miokardnu mehaniku kod hroničnih HD bolesnika. U studiji je učestvovalo 83 HD bolesnika kojima nikada ranije nije rađeno merenje volemije BIS-om i studija je trajala devet meseci. Srčana struktura i funkcionalne karakteristike procenjivane su dvodimenzionalnom Dopler ehokardiografijom, a globalno naprezanje speckle-tracking modalitetom. Određivani su nivoi kardioloških markera u krvi. Rezultati. Studiju je završilo 73 bolesnika (38 u aktivnoj - AKV grupi i 35 u kontrolnoj grupi). Na kraju studije, glavna strukturna promena u aktivnoj grupi bolesnika bila je redukcija indeksa mase leve komore (62,81 ± 19,74 g/m2,7 na početku studije i 57,74 ± 16,87 g/m2,7 na kraju studije, p = 0,007), dok su glavna funkcionalna poboljšanja u ovoj grupi bolesnika bila poboljšanje ejekcione frakcije leve komore (LVEF, sa 41,27 ± 9,26% na 43,95 ± 8,84%, p = 0,006) i njenog frakcionog skraćenja (FS; 27,86 ± 5,94% do 29,86 ± 5,83%, p = 0,056), u skladu sa poboljšanjem radijalne mehanike miokarda leve komore registrovanog višim globalnim radijalnim naprezanjem (strain-om) (GRS) na kraju studije (18,56 ± 10,24% do 21,79 ± 12,16%, p = 0,014). Bolesnici u kontrolnoj grupi imali su značajno pogoršanje dijastolne funkcije procenjeno na osnovu porasta odnosa Doplera brzine ranog dijastolnog punjenja leve komore - E i srednje brzine tkivnog Doplera lateralnog dela mitralnog anulusa - e' (E/e' lateralno; 10,59 ± 5,00 do 11,12 ± 4,06; p = 0,036) i posledično, povišenim sistolnim pritiskom u desnoj komori (SPDK, od 34,84 ± 10,18 mmHg do 38,76 ± 8,34 mmHg; p = 0,028). Ove funkcionalne promene kod bolesnika u kontrolnoj grupi korelirale su sa značajnim pogoršanjem nivoa N-terminalnog prohormona moždanog natriuretskog peptida (NT-proBNP): medijana i interkvartalni rasopon (IQR) od 5810,0 pg/mL (3339,0-15627,0 pg/mL) na početku studije do 8024,0 pg/mL (4433,0-17467,0 pg/mL; p = 0,038), na kraju studije. Poboljšanje srčane morfologije i funkcije u aktivnoj grupi korelirao je sa značajnim smanjenjem procenta "kritično" hipervolemičnih bolesnika na kraju studije (sa 45% na 24%; p = 0,003). Na kraju studije, postdijalizno "kritično" dehidriranih bolesnika u kontrolnoj grupi bilo je 49%. Procenat anuričnih bolesnika porastao je samo u ovoj grupi, sa 63% na 77% (p = 0,063). Zaključak. Koncept aktivne kontrole volemije vođene bioimpedantnom spektroskopijom pozitivno je uticao na hemodinamiku i mehaniku srca kod bolesnika na hroničnom lečenju hemodijalizom i može da pomogne u kliničkom određivanju njihove optimalne težine i daljem kliničkom toku. Potrebni su što pre dodatni podaci o ovom problemu iz dobro dizajniranih studija.
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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP170325058P
objavljen u SCIndeksu: 08.02.2020.
metod recenzije: dvostruko anoniman
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