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혈액투석 환자에서 생체 임피던스로 측정한 부종지수와 활동혈압의 상관관계 및 부종지수를 이용한 건체중 조절의 유용성

Influences of Dry Weight Adjustment Based on Bioimpedance Analysis on Ambulatory Blood Pressure in Hemodialysis Patients

김수현|홍문기|김채림|신정호|유석희
대한고혈압학회 (The Korean Society of Hypertension)|2012.12|Clinical Hypertension|제18권 제4호|pp. 166-175|DOI http://dx.doi.org/10.5646/jksh.2012.18.4.166

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키워드

HypertensionAmbulatory blood pressure monitoringRenal dialysis

초록

연구배경: 혈액투석을 받는 환자에서 고혈압은 흔하게나타나며, 이는 심혈관계 사망률의 증가와 관련되어 있다. 본 연구에서는 혈액투석 환자들의 활동혈압을 분석하고, 건체중의 조절을 통해 혈압조절에 도움이 될 수 있는지 알아보았다. 방법: 중앙대학교병원에서 3개월 이상 혈액투석을 시행한 환자들을 대상으로 하였다. 24시간 활동혈압은 혈액투석 후 24시간 동안 측정되었고, 생체 임피던스분석은 혈액투석 전 누운 자세로 측정하였다. 환자들은 생체 임피던스분석을 통해 계산된 부종지수에 따라 두 군으로 분류되었다. 부종지수가 0.40 미만인 환자는 정상체액군, 부종지수가 0.40 이상인 경우 과체액군으로 분류되었다. 생체 임피던스분석을 추적하며 전향적으로 체중을 조절하였고 이에 따른 혈압의 변화를 관찰하였다. 결과: 36명의 환자들 중 남자가 22명, 여자는 14명이 포함되었다. 24시간 수축기혈압은 140.2 ± 19.7 mm Hg, 24시간 확장기혈압은 79.0 ± 10.6 mm Hg로 측정되었고, 부종지수와 평균 수축기혈압 간의 높은 상관관계를 확인할수 있었다(r = 0.501, p = 0.002). 정상체액군의 24시간 수축기혈압은 중위수 132.0 mm Hg인데 반해 과체액군의24시간 수축기혈압은 중위수 150.5 mm Hg로 두 군 간에의미 있는 차이를 보였다(p = 0.008). 체중조절 후 과체액군의 부종지수는 0.411 ± 0.009에서 0.389 ± 0.047로 감소하였고, 이에 진료실 수축기혈압도 144.7 ± 32.7 mm Hg에서 125.3 ± 15.4 mm Hg로 의미 있게 감소하였다(각각 p = 0.028, p = 0.018). 결론: 혈액투석 환자에서 생체 임피던스분석을 통해 계산된 부종지수는 24시간 수축기혈압과 높은 상관관계를보인다. 그러므로, 혈액투석 환자에서 건체중을 조절함으로써 혈압조절에 도움이 될 수 있다.

Abstract

Background: Hypertension is a common problem for hemodialysis patients and is associated with an increased cardiovascular mortality. We analyzed ambulatory blood pressure (ABP) in hemodialysis patients and investigated if an adjustment of dry weight can be used to control blood pressure. Methods: ABP was measured for twenty-four hours after hemodialysis. A bioimpedance Analysis (BIA) was conducted. Patients were divided into two groups by the edema index. A normohydration (NH) group included patients with the edema index less than 0.40, and an overhydration (OH) group included patients with the edema index 0.40 or more. We accordingly adjusted the dry weight based on BIA results. Results:Thirty-six patients were recruited, comprising twenty-two men and fourteen women. In regard to the ABP, 24-hour systolic and diastolic blood pressures were 140.2 ± 19.7 mm Hg and 79.0 ± 10.6 mm Hg, respectively. There was a significant association between 24-hour systolic blood pressure and the edema index (r = 0.501, p = 0.002). Twenty four-hour systolic blood pressure was significantly different between the NH and OH groups (median value, 132.0 vs. 150.5 mm Hg; p =0.008). In OH group, after adjustment of the dry weight, the edema index was decreased from 0.411 ± 0.009 to 0.389 ±0.047 and office systolic blood pressure was also decreased from 144.7 ± 32.7 mm Hg to 125.3 ± 15.4 mm Hg in OH group (p = 0.028 and p = 0.018, respectively). Conclusions: The edema index obtained by the bioimpedance analysis is significantly correlated with 24-hour systolic blood pressure in hemodialysis patients. Also, an adjustment of dry weight can be used to control blood pressure in hemodialysis patients.

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