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中华肾病研究电子杂志 ›› 2016, Vol. 05 ›› Issue (03) : 101 -104. doi: 10.3877/cma.j.issn.2095-3216.2016.03.002

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浅谈腹膜透析患者的血压管理
丁小强1,(), 吉俊1   
  1. 1. 200032 上海,复旦大学附属中山医院肾脏科、上海市肾病与透析研究所、上海市肾脏疾病与血液净化重点实验室、上海市血液透析质量控制中心
  • 收稿日期:2016-04-21 出版日期:2016-06-28
  • 通信作者: 丁小强

Blood pressure management in peritoneal dialysis patients

Xiaoqiang Ding1,(), Jun Ji1   

  1. 1. Department of Nephrology, Zhongshan Hospital Affiliated to Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney Disease and Blood Purification, Shanghai Center for Hemodialysis Quality Control, Shanghai 200032, China
  • Received:2016-04-21 Published:2016-06-28
  • Corresponding author: Xiaoqiang Ding
  • About author:
    Corresponding author: Ding Xiaoqiang, Email:
引用本文:

丁小强, 吉俊. 浅谈腹膜透析患者的血压管理[J]. 中华肾病研究电子杂志, 2016, 05(03): 101-104.

Xiaoqiang Ding, Jun Ji. Blood pressure management in peritoneal dialysis patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2016, 05(03): 101-104.

腹膜透析患者的高血压患病率达80%以上,难治性高血压导致卒中、心血管事件发病率不断增加,是患者死亡和退出腹膜透析的主要原因。2015年国际腹膜透析协会(ISPD)关于成人腹膜透析患者心血管和代谢指南指出,持续腹膜透析患者目标血压应<140/90 mmHg,并与年龄无关。腹膜透析患者血压控制不佳的影响因素纷繁复杂,但常见原因是容量超负荷和残肾功能减退。腹膜透析患者高血压防治策略包括容量负荷的准确评估与干预、残余肾功能的有效保护、透析处方的及时调整,降压药物的正确选择以及以病人为中心的团队管理等五个方面。

Hypertension is extremely common in patients on peritoneal dialysis (PD), with a prevalence of more than 80%. Moreover, refractory hypertension accounts for the increasing incidence of stroke and cardiovascular events which are the leading causes for death and peritoneal dialysis dropout. The 2015 International Society of Peritoneal Dialysis cardiovascular and metabolic guidelines for adult peritoneal dialysis patients recommended that the target of blood pressure in continuous ambulatory PD patients should be <140 mmHg systolic and <90 mmHg diastolic, irrespective of age. There are various factors that contribute to the poor control of hypertension in PD patients, of which hypervolumia and reduced residual renal function are the most common ones. Therapeutic strategies for blood pressure management in PD patients include 5 aspects: appropriate assessment on volume status, effective protection of residual renal function, flexible adjustment of dialysis prescription, right choice of anti-hypertensive drugs, and patient-centered team management.

表1 近年颁布的国内外高血压管理指南血压控制靶目标
表2 优秀腹膜透析团队对腹膜透析患者高血压管理的工作细节
[1]
Cocchi R,DegliEsposti E,Fabbri A, et al. Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study[J]. Nephrol Dial Transplant, 1999, 14(6): 1536-1540.
[2]
Koc M,Toprak A,Tezcan H, et al. Uncontrolled hypertension due to volume overload contributes to higher left ventricular mass index in CAPD patients[J]. Nephrol Dial Transplant, 2002, 17(9): 1661-1666.
[3]
Chiang CE,Wang TD,Ueng KC, et al. 2015 Guidelines of the Taiwan society of cardiology and the Taiwan hypertension society for the management of hypertension[J]. J Chin Med Assoc, 2014, 78(1): 1-47.
[4]
Wang AYM,Brimble KS,Brunier G, et al. ISPD cardiovascular and metabolic guidelines in adult peritoneal dialysis patients[J]. Perit Dial Int, 2015, 35(4): 379-387.
[5]
Wang X,Axelsson J,Lindholm B, et al. Volume status and blood pressure in continuous ambulatory peritoneal dialysis patients[J]. Blood Purif, 2005, 23(5): 373-378.
[6]
Medcalf JF,Harris KP,Walls J. Role of diuretics in the preservation of residual renal functionin patients on continuous ambulatory peritoneal dialysis[J]. Kidney Int, 2001, 59(3): 1128-1133.
[7]
Goldfarb-Rumyantzev AS,Baird BC,Leypoldt JK, et al. The association between BP and mortality in patients on chronic peritoneal dialysis[J]. Nephrol Dial Transplant, 2005, 20(8): 1693-1701.
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