Agarwal Rajiv, Peixoto Aldo J, Santos Sergio F F, Zoccali Carmine
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA.
Clin J Am Soc Nephrol. 2006 May;1(3):389-98. doi: 10.2215/CJN.01891105. Epub 2006 Apr 12.
BP readings that are obtained in the dialysis unit are commonly used to make therapeutic decisions by clinicians and to predict morbidity and mortality by epidemiologists. Dialysis unit BP are also incorporated in the recent guidelines to target BP control. The magnitude of the difference, overestimation or underestimation, and agreement between dialysis unit BP and ambulatory BP (ABP) are unknown. Articles were selected from Medline to identify those that reported both ABP and dialysis unit BP in hemodialysis patients. Bias was calculated as the difference between dialysis unit and the corresponding ABP. Agreement limits between the BP measurement techniques were assessed by pooled SD of the difference using Bland-Altman methods. Predialysis systolic BP generally overestimated ABP by a variable amount. The heterogeneity between BP measurements did not allow for pooling of the estimates. The agreement limits between the two BP was 41.7 to -25.2 mmHg. Predialysis diastolic BP also generally overestimated the ABP with wide agreement limits (23.7 to -18.9 mmHg). In contrast, postdialysis BP underestimated average ABP with wide agreement limits for both postdialysis systolic BP (33.1 to -36.3 mmHg) and diastolic BP (19.3 to -23.9 mmHg). Dialysis unit BP measurements are imprecise estimates of ABP. Better methods are needed for the assessment of BP in hemodialysis patients for clinical decision making.
在透析单元测得的血压读数通常被临床医生用于做出治疗决策，并被流行病学家用于预测发病率和死亡率。透析单元血压还被纳入最近的血压控制指南中。透析单元血压与动态血压（ABP）之间差异的大小、高估或低估情况以及一致性尚不清楚。从医学文献数据库（Medline）中选取文章，以识别那些报告了血液透析患者ABP和透析单元血压的文章。偏差计算为透析单元血压与相应ABP之间的差值。使用布兰德-奥特曼方法通过差值的合并标准差评估血压测量技术之间的一致性界限。透析前收缩压通常会不同程度地高估ABP。血压测量之间的异质性不允许对估计值进行合并。两种血压之间的一致性界限为41.7至 -25.2 mmHg。透析前舒张压通常也会高估ABP，一致性界限较宽（23.7至 -18.9 mmHg）。相比之下，透析后血压低估了平均ABP，透析后收缩压（33.1至 -36.3 mmHg）和舒张压（19.3至 -23.9 mmHg）的一致性界限都较宽。透析单元血压测量是对ABP的不精确估计。需要更好的方法来评估血液透析患者的血压以用于临床决策。
