Mourad Adnan, Khoshdel Alireza, Carney Shane, Gillies Alastair, Jones Bernard, Nanra Ranjit, Trevillian Paul
Department of Nephrology, John Hunter Hospital, New Lambton Heights, NSW, Australia.
Nephrology (Carlton). 2005 Oct;10(5):438-41. doi: 10.1111/j.1440-1797.2005.00467.x.
The importance of 'conventional' cardiovascular risk factors in haemodialysis (HD) patients has been questioned following evidence that pre-HD blood pressure (BP) might be inversely related to mortality in contrast to post-HD BP. To evaluate this reverse BP epidemiology in HD patients, HD-induced BP changes were compared with aortic pulse wave velocity (PWV), an independent predictor of cardiovascular mortality.
Aortic PWV was evaluated in a limited care HD cohort, all of whom were asymptomatic of cardiovascular disease.
Of 47 limited care patients, 45% were classified as HD responsive, with a 17% fall in mean arterial pressure compared with a 6% increase in the HD-unresponsive group. While there were no significant differences between the two groups in traditional vascular disease risk factors or interdialytic weight loss, PWV was significantly elevated in the HD-unresponsive group (12.9 +/- 2.7 compared with 10.8 +/- 2.9; P < 0.05). Furthermore, there was a positive correlation between the change in BP during HD and PWV in all subjects (r = 0.500; P < 0.001 for systolic blood pressure (SBP), a correlation that also existed for diastolic blood pressure (DBP) (P < 0.01).
This study suggests that patients with HD-unresponsive BP are more likely to have vascular disease and this association between PWV and HD-induced BP changes might partly explain the apparent paradox of pre- and post-HD BP with mortality. It is proposed that a population with elevated post-HD BP is more likely to be composed of subjects with vascular disease (overt or occult), in contrast to a group with high pre-HD BP, which will be more heterogeneous.
有证据表明，与透析后血压相比，透析前血压（BP）可能与死亡率呈负相关，这使得“传统”心血管危险因素在血液透析（HD）患者中的重要性受到质疑。为了评估HD患者中这种反向血压流行病学情况，将HD引起的血压变化与主动脉脉搏波速度（PWV）进行了比较，PWV是心血管死亡率的一个独立预测指标。
在一个有限护理HD队列中评估主动脉PWV，所有患者均无心血管疾病症状。
在47例有限护理患者中，45%被归类为HD反应型，平均动脉压下降17%，而HD无反应组上升6%。虽然两组在传统血管疾病危险因素或透析间期体重减轻方面无显著差异，但HD无反应组的PWV显著升高（12.9±2.7对比10.8±2.9；P<0.05）。此外，所有受试者HD期间血压变化与PWV之间存在正相关（收缩压（SBP）r=0.500；P<0.001，舒张压（DBP）也存在这种相关性（P<0.01）。
本研究表明，HD无反应性血压患者更易患血管疾病，PWV与HD引起的血压变化之间的这种关联可能部分解释了HD前后血压与死亡率之间明显的矛盾现象。有人提出，与HD前血压高的人群相比，HD后血压升高的人群更可能由患有血管疾病（显性或隐性）的受试者组成，HD前血压高的人群则更为异质。
