臨牀透析 Vol.27 No.9(1-3)


特集名 透析患者と血圧異常
題名 [総論─CKDと血圧]評価法
発刊年月 2011年 08月
著者 宮坂 康宣 仙台社会保険病院腎疾患臨床研究センター
著者 佐藤 壽伸 仙台社会保険病院腎疾患臨床研究センター
【 要旨 】 慢性腎臓病(CKD)患者では,高血圧は心血管病発症や生命予後に影響する.とくに透析患者(CKD-5D)では心血管系合併症が死亡・ADL低下の主因であり,血圧異常の評価は重要である.しかし透析患者では血圧の重要な規定因子である細胞外液量は透析時・非透析時ともに時間とともに変化し,末血管抵抗の調節能も障害されている.このため透析室血圧,家庭血圧や自由行動下血圧測定(ABPM)の結果を総合して血圧管理を行うことが望ましい.また透析患者では血管の弾性機能低下が収縮期血圧の上昇や脈圧の増大に深く関っており,脈波伝播速度(PWV)・CAVI・足関節―上腕血圧比(ABI)などの方法による弾性血管の機能評価が重要である.
Theme Abnormal Blood Pressure in Dialysis Patients
Title Evaluation of blood pressure in CKD
Author Yasunori Miyasaka Department of Nephrology, Sendai Shakaihoken Hospital
Author Toshinobu Sato Department of Nephrology, Sendai Shakaihoken Hospital
[ Summary ] In patients with chronic kidney disease (CKD), hypertension has a particular influence on cardiovascular morbidity and mortality. Patients receiving dialysis (CKD-5D), are especially prone to cardiovascular disease, which is a major cause of death and decreased activity levels. Therefore, in terms of treatment for CKD patients, it is important to evaluate blood pressure correctly. However, in patients receiving hemodialysis, extracellular fluid volume is an important factor, regulating blood pressure changes during dialysis treatment. In addition, the regulation of peripheral vascular resistance is also altered in CKD. As a result, the blood pressure should be treated in terms of considering blood pressure in dialysis centers, in home blood pressure monitoring and ABPM. Evaluation of blood vessel elasticity using PWV, CAVI and ABI is also important, because the elasticity of blood vessels is involved in increases in diastolic hypertension and pulse pressure.
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