Wijaya Adi, Marbun Maruhum Bonar Hasiholan, Nugroho Pringgodigdo, Rinaldi Ikhwan
Internal Medicine, Cipto Mangunkusumo Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, IDN.
Cureus. 2023 Aug 30;15(8):e44381. doi: 10.7759/cureus.44381. eCollection 2023 Aug.
Fluid overload causes excessive systemic vasoconstriction and decreased perfusion of peripheral tissues, leading to abnormalities in cardiopulmonary physiological functions. Prolonged fluid overload caused by inadequate hemodialysis may cause heart dilatation, left ventricular hypertrophy, hypertension, and a decrease in coronary reserves, which later will develop into coronary ischemia, leading to increased morbidity and mortality of cardiovascular disease (CVD). Endothelial dysfunction plays a role in excessive vasoconstriction on fluid overload. Brain natriuretic peptide (BNP) and asymmetric dimethylarginine (ADMA) are used as parameters of fluid overload and endothelial dysfunction, respectively. This study is conducted to describe the relationship between fluid overload with endothelial dysfunction.
This study is a cross-sectional study of kidney failure patients who underwent hemodialysis twice weekly for at least three months. BNP and ADMA were used as parameters for fluid overload and taken prior to hemodialysis.
From 126 subjects, the proportion with fluid overload (BNP>356 pg/ml) was found to be 64.3% with the median age of subjects being 52 years (47-62). There was 47.6% population with endothelial dysfunction (ADMA>100 ng/ml). Presumptive causes of primary chronic kidney disease (CKD) were hypertension (38.9%), diabetes mellitus (DM) (28.6%), and glomerulonephritis (21.4%). There was no significant association between fluid overload and endothelial dysfunction (PR=1,042, p=0.832 CI 95%=0.714-1.521).
There was no relationship between fluid overload and endothelial dysfunction.
液体超负荷会导致全身血管过度收缩，外周组织灌注减少，从而引起心肺生理功能异常。血液透析不充分导致的长期液体超负荷可能会引起心脏扩张、左心室肥厚、高血压以及冠状动脉储备下降，随后会发展为冠状动脉缺血，导致心血管疾病（CVD）的发病率和死亡率增加。内皮功能障碍在液体超负荷引起的血管过度收缩中起作用。脑钠肽（BNP）和不对称二甲基精氨酸（ADMA）分别用作液体超负荷和内皮功能障碍的指标。本研究旨在描述液体超负荷与内皮功能障碍之间的关系。
本研究是一项横断面研究，对象为每周接受两次血液透析至少三个月的肾衰竭患者。BNP和ADMA用作液体超负荷的指标，在血液透析前采集。
在126名受试者中，发现液体超负荷（BNP>356 pg/ml）的比例为64.3%，受试者的中位年龄为52岁（47-62岁）。有47.6%的人群存在内皮功能障碍（ADMA>100 ng/ml）。原发性慢性肾脏病（CKD）的推测病因是高血压（38.9%）、糖尿病（DM）（28.6%）和肾小球肾炎（21.4%）。液体超负荷与内皮功能障碍之间无显著关联（PR=1.042，p=0.832，95%CI=0.714-1.521）。
液体超负荷与内皮功能障碍之间无关联。
