Mazzuchi N, Carbonell E, Fernández-Cean J
Instituto de Nefrología y Urología, Servicio de Asistencia Renal Integral, Montevideo, Uruguay.
Kidney Int. 2000 Nov;58(5):2147-54. doi: 10.1111/j.1523-1755.2000.00388.x.
In the general population, hypertension is the leading cause of cardiovascular mortality. In dialysis patients, however, the relationship between blood pressure (BP) and mortality is controversial. We analyzed this relationship in hemodialysis (HD) patients.
The study population included 405 patients who had survived at least two years on HD. The observation period was initiated at the beginning of the third year. Predialysis BP measurements of all the dialysis treatments performed during the second year of HD was collected as the baseline data. Mean systolic BP (SBP) and mean diastolic BP (DBP) were calculated. Demographic and comorbidity data were collected at the start of the observation period (beginning of third year of HD). Mortality was analyzed at the end of the follow-up (death or December 31, 1998; total mortality), during the first two years of follow-up (years 3 and 4 of HD; early mortality) and after the second year of follow-up (> or = 5 years of HD; late mortality).
In the multivariate analysis, SBP and DBP were significantly associated with death. The adjusted total mortalities were U shaped. When early mortality was analyzed, only low BP (DBP <74.5 mm Hg) was significantly associated with mortality. When late mortality was analyzed, only high BP (SBP> 160 mm Hg) was significantly associated with mortality. In the early deaths, a cardiac cause was significantly less frequent, while withdrawal and malignancy were more frequent than in late deaths.
This study confirms that hypertension is a risk factor for mortality in HD patients, and shows the importance of the length of the follow-up time to demonstrate this relationship. The low frequency of a cardiac cause in the early death group suggests that the association between hypotension and mortality in HD patients is not related to cardiovascular causes, and only reflects the association between hypotension and other severe medical conditions.
在普通人群中，高血压是心血管疾病死亡的主要原因。然而，在透析患者中，血压（BP）与死亡率之间的关系存在争议。我们分析了血液透析（HD）患者中的这种关系。
研究人群包括405例接受HD至少两年的存活患者。观察期从第三年开始。收集HD第二年期间所有透析治疗的透析前血压测量值作为基线数据。计算平均收缩压（SBP）和平均舒张压（DBP）。在观察期开始时（HD第三年开始）收集人口统计学和合并症数据。在随访结束时（死亡或1998年12月31日；总死亡率）、随访的前两年（HD第3年和第4年；早期死亡率）以及随访的第二年之后（HD≥5年；晚期死亡率）分析死亡率。
在多变量分析中，SBP和DBP与死亡显著相关。调整后的总死亡率呈U形曲线。分析早期死亡率时，只有低血压（DBP<74.5 mmHg）与死亡率显著相关。分析晚期死亡率时，只有高血压（SBP>160 mmHg）与死亡率显著相关。在早期死亡中，心脏原因导致的死亡明显较少，而退出治疗和恶性肿瘤导致的死亡比晚期死亡更常见。
本研究证实高血压是HD患者死亡的危险因素，并表明随访时间长度对于证明这种关系的重要性。早期死亡组中心脏原因导致的死亡频率较低，这表明HD患者中低血压与死亡率之间的关联与心血管原因无关，仅反映了低血压与其他严重疾病之间的关联。
