維持透析患者にみられる持続性低血圧症に関する臨床的研究

Abstract

From the viewpoint of rehabilitation and quality of life, persistent (chronic) hypotension has been focused on as a serious complication of maintenance hemodialysis in patients with chronic renal failure. In this study, 32 hemodialysed patients were categorized into three groups according to their blood pressure as follows, hypertensive (n=5), normotensive (n=14) and hypotensive patients (n=13). To elucidate some etiologic factors responsible for the pathogenesis of chronic hypotension, a variety of the factors regulating blood pressure, such as plasma renin activity, plasma levels of angiotensin Ⅱ, aldosterone, noradrenaline, α-human atrial natriuretic peptide (h-ANP) and sodium content in erythrocyte, were investigated. In addition, Valsalva index was measured as a parameter indicative of baroreflex sensitivity in the autonomic nervous system. The conclusions confirmed in this study were as follows : 1) The renin-aldosterone system might not particle in the pathogenesis of chronic hypotension. 2) No evidence could be found to support the hypothesis that h-ANP would be one of the etiologic factors in the development of chronic hypotension. 3) An impaired baroreflex sensitivity was closely linked with the pathogenesis of this clinical entity. 4) As an another important factor, a down regulation between noradrenaline and peripheral vessel was strongly suggested.