Bleyer A J, Hartman J, Brannon P C, Reeves-Daniel A, Satko S G, Russell G
Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina 27157, USA.
Kidney Int. 2006 Jun;69(12):2268-73. doi: 10.1038/sj.ki.5000446. Epub 2006 May 3.
Hemodialysis (HD) is an intermittent procedure during which large fluid and electrolyte shifts occur. We hypothesized that sudden death occurrences in HD patients are related to the timing of HD, and that they occur more frequently in the 12 h period starting with dialysis and in the 12 h period at the end of the dialysis-free weekend interval. In a retrospective study, 228 patient deaths were screened to determine if they met the criteria for sudden death. Information was obtained from clinic charts, dialysis center records, and interview of witnesses of the death event. There were 80 HD patients who met the criteria for sudden death. A bimodal distribution of death occurrences was present, with a 1.7-fold increased death risk occurring in the 12 h period starting with the dialysis procedure and a threefold increased risk of death in the 12 h before HD at the end of the weekend interval (P=0.011). Patients with sudden death had a high prevalence of congestive heart failure and coronary artery disease. Only 40% of patients experiencing sudden death were receiving beta-blockers, and the prior monthly serum potassium value was less than 4 mEq/l in 25%. Sudden death is temporally related to the HD procedure. Every other day HD could be beneficial in preventing sudden death. Careful attention to the usage of beta-blockers and to the maintenance of normal serum potassium values is indicated in HD patients at risk for sudden death.
血液透析（HD）是一个会发生大量液体和电解质转移的间歇性过程。我们推测HD患者的猝死与HD的时间安排有关，且在开始透析后的12小时内以及无透析周末间隔结束时的12小时内更频繁发生。在一项回顾性研究中，筛查了228例患者的死亡情况，以确定他们是否符合猝死标准。信息来自临床病历、透析中心记录以及对死亡事件目击者的访谈。有80例HD患者符合猝死标准。死亡发生呈双峰分布，从透析过程开始的12小时内死亡风险增加1.7倍，在周末间隔结束时HD前的12小时内死亡风险增加3倍（P = 0.011）。猝死患者中充血性心力衰竭和冠状动脉疾病的患病率较高。仅有40%经历猝死的患者正在接受β受体阻滞剂治疗，25%的患者之前每月血清钾值低于4 mEq/l。猝死在时间上与HD过程相关。隔日进行血液透析可能有助于预防猝死。对于有猝死风险的HD患者，建议密切关注β受体阻滞剂的使用以及维持正常血清钾值。
