Sasaki Osamu, Nakahama Hajime, Nakamura Satoko, Yoshihara Fumiki, Inenaga Takashi, Yoshii Masayoshi, Kohno Shigeru, Kawano Yuhei
Division of Hypertension and Nephrology, National Cardiovascular Center, Fujishirodai 5-7-1, Suita 565-8565, Osaka, Japan.
Nephrol Dial Transplant. 2005 Feb;20(2):377-81. doi: 10.1093/ndt/gfh614. Epub 2004 Dec 23.
Since the predictive value of orthostatic hypotension (OH) at the introductory phase of haemodialysis (HD) is unknown, we examined the association between OH and all-cause death in patients who started HD between 1987 and 2001.
More than three consecutive blood pressure measurements before HD treatments (pre-HD BP) were made on each of 304 patients who had recently been started on HD and were in a stable condition. OH was defined as a drop in systolic BP of >20 mmHg or in diastolic BP of >10 mmHg after standing.
Of 304 patients, 42% had OH. OH was significantly associated with pre-HD supine systolic BP; its severity was significantly associated with a past history of cerebrovascular disease and pre-HD supine systolic BP. During a mean follow-up of 4.0+/-3.0 years (range 0.1-13.2 years), 136 deaths were recorded. A multivariate Cox proportional hazards model analysis demonstrated that OH and a past history of cerebrovascular disease were independent predictors of all-cause death. The comparison by Kaplan-Meier analysis of the overall survival of patients with and without OH was significant.
Our findings validate OH at the introductory phase of HD as a novel independent predictor of all-cause mortality among HD patients.
由于血液透析（HD）起始阶段直立性低血压（OH）的预测价值尚不清楚，我们研究了1987年至2001年间开始进行HD治疗的患者中OH与全因死亡之间的关联。
对304例近期开始HD治疗且病情稳定的患者，在每次HD治疗前连续测量三次以上血压（HD治疗前血压）。OH定义为站立后收缩压下降>20 mmHg或舒张压下降>10 mmHg。
304例患者中，42%有OH。OH与HD治疗前仰卧位收缩压显著相关；其严重程度与脑血管疾病病史和HD治疗前仰卧位收缩压显著相关。在平均4.0±3.0年（范围0.1 - 13.2年）的随访期间，记录到136例死亡。多变量Cox比例风险模型分析表明，OH和脑血管疾病病史是全因死亡的独立预测因素。通过Kaplan-Meier分析比较有OH和无OH患者的总生存率，差异有统计学意义。
我们的研究结果证实HD起始阶段的OH是HD患者全因死亡率的一种新的独立预测因素。
