Foley Robert N, Herzog Charles A, Collins Allan J
Cardiovascular Special Studies Center, United States Renal Data System, Minneapolis, Minnesota, USA.
Kidney Int. 2002 Nov;62(5):1784-90. doi: 10.1046/j.1523-1755.2002.00636.x.
The long-term prognostic associations of pre- and post-dialysis blood pressures, interdialytic weight gain, and antihypertensive use in hemodialysis patients are unclear.
The United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Waves 3 and 4 Study, a randomly generated sample of 11,142 subjects receiving hemodialysis on December 31, 1993, was examined, with vital status followed until May 2000.
Pre- and post-dialysis blood pressure values, interdialytic weight gain and number of antihypertensives averaged 151.8/79.7, 137.0/74, 3.6% and 0.76, respectively. Prognostic discrimination was maximized by considering pre- and post-systolic and diastolic blood pressure values simultaneously, in a pattern suggesting that wide pulse pressures were associated with mortality (P < 0.0001). Comorbidity adjustment markedly affected associations, with low pre-dialysis diastolic (P < 0.05), low post-dialysis dialysis diastolic pressure (P < 0.05), high post-dialysis dialysis systolic pressure (P < 0.05), and high interdialytic weight gains (P = 0.005) associated with mortality. Each class of antihypertensive drug, except angiotensin-converting enzyme (ACE)-inhibitors, was associated with lower mortality in unadjusted models, an effect most pronounced for beta-blockers (hazards ratio 0.72, 95% CI 0.66 to 0.79, P < 0.0001). Comorbidity adjustment eliminated survival associations for each antihypertensive class except beta-blockers.
Pre- and post-dialysis blood pressure values have independent associations with mortality, in a way that implicates wide pulse pressures. Much of the adverse prognosis of wide pulse pressures probably reflects older age and cardiovascular comorbidity. Large interdialytic weight gains are associated with shorter survival when comorbidity is taken into account. Beta-blocker use shows a robust association with survival, and may be protective.
血液透析患者透析前和透析后的血压、透析间期体重增加以及抗高血压药物使用的长期预后关联尚不清楚。
对美国肾脏数据系统（USRDS）第3和第4次透析发病率和死亡率研究进行了分析，该研究是对1993年12月31日接受血液透析的11142名受试者的随机抽样，随访其生命状态直至2000年5月。
透析前和透析后的血压值、透析间期体重增加以及抗高血压药物的数量平均分别为151.8/79.7、137.0/74、3.6%和0.76。通过同时考虑透析前和透析后的收缩压和舒张压值，预后判别达到最大化，其模式表明脉压增宽与死亡率相关（P < 0.0001）。合并症调整显著影响关联，透析前舒张压较低（P < 0.05）、透析后舒张压较低（P < 0.05）、透析后收缩压较高（P < 0.05）以及透析间期体重增加较多（P = 0.005）均与死亡率相关。在未调整的模型中，除血管紧张素转换酶（ACE）抑制剂外，每类抗高血压药物均与较低的死亡率相关，β受体阻滞剂的这种作用最为明显（风险比0.72，95%可信区间0.66至0.79，P < 0.0001）。合并症调整消除了除β受体阻滞剂外各抗高血压药物类别与生存率的关联。
透析前和透析后的血压值与死亡率存在独立关联，这种关联涉及脉压增宽。脉压增宽的许多不良预后可能反映了年龄较大和心血管合并症。考虑合并症时，透析间期体重增加较多与生存期较短相关。使用β受体阻滞剂与生存率存在显著关联，可能具有保护作用。
