Inrig Jula K, Patel Uptal D, Toto Robert D, Szczech Lynda A
Department of Medicine, UT Southwestern Medical Center, Dallas, TX 75390-8523, USA.
Am J Kidney Dis. 2009 Nov;54(5):881-90. doi: 10.1053/j.ajkd.2009.05.012. Epub 2009 Jul 30.
Intradialytic increases in blood pressure (BP) can complicate the management of hypertension in hemodialysis (HD) patients. However, the long-term consequences are uncertain. Thus, we sought to determine whether BP increases during HD were associated with greater 2-year mortality in incident HD patients.
Secondary analysis of a prospective dialysis cohort.
SETTING & PARTICIPANTS: Incident HD patients in the Dialysis Morbidity and Mortality Wave 2 Study.
Changes in systolic BP (SBP) during HD (ie, postdialysis SBP -- predialysis SBP), averaged from 3 HD sessions before enrollment.
Time to 2-year all-cause mortality.
Cox regression was used to model hazard ratios for mortality associated with changes in SBP during HD while adjusting for demographics, comorbid conditions, interdialytic weight gain, laboratory variables, and antihypertensive agents.
Of 1,748 patients, 12.2% showed greater than 10-mm Hg increases in SBP during HD. In adjusted analyses, every 10-mm Hg increase in SBP during HD was associated independently with a 6% increased hazard of death (hazard ratio, 1.06; 95% confidence interval, 1.01 to 1.11). When also adjusted for diastolic BP and postdialysis SBP, the adjusted hazard of death associated with increasing SBP during HD remained significant (hazard ratio, 1.12; 95% confidence interval, 1.05 to 1.21 per 10-mm Hg increase in SBP during HD). However, in analyses adjusted for predialysis SBP, there was a significant interaction between change in SBP and predialysis SBP. In analyses stratified by predialysis SBP, trends for increased mortality associated with increasing SBP during dialysis were present in patients with predialysis SBP less than 160 mm Hg. However, this relationship was significant only in patients with predialysis SBP less than 120 mm Hg.
Secondary analysis with a limited number of baseline BP measurements and limited information about dialysis prescription.
Increasing SBP by more than 10 mm Hg during HD occurs in approximately 10% of incident patients, and although increasing SBP during HD was associated with decreased 2-year survival, these findings were limited to patients with predialysis SBP less than 120 mm Hg.
血液透析（HD）期间血压（BP）升高会使HD患者的高血压管理变得复杂。然而，其长期后果尚不确定。因此，我们试图确定HD期间血压升高是否与新发HD患者2年死亡率增加有关。
对前瞻性透析队列进行二次分析。
透析发病率和死亡率第2波研究中的新发HD患者。
HD期间收缩压（SBP）的变化（即透析后SBP减去透析前SBP），取入组前3次HD治疗的平均值。
2年全因死亡率的时间。
使用Cox回归模型对HD期间SBP变化与死亡率相关的风险比进行建模，同时调整人口统计学、合并症、透析间期体重增加、实验室变量和抗高血压药物。
在1748例患者中，12.2%的患者在HD期间SBP升高超过10 mmHg。在调整分析中，HD期间SBP每升高10 mmHg与死亡风险增加6%独立相关（风险比，1.06；95%置信区间，1.01至1.11）。当同时调整舒张压和透析后SBP时，HD期间SBP升高与死亡相关的调整后风险仍然显著（风险比，1.12；HD期间SBP每升高10 mmHg，95%置信区间，1.05至1.21）。然而，在根据透析前SBP进行调整的分析中，SBP变化与透析前SBP之间存在显著交互作用。在按透析前SBP分层的分析中，透析期间SBP升高与死亡率增加的趋势在透析前SBP低于160 mmHg的患者中存在。然而，这种关系仅在透析前SBP低于120 mmHg的患者中显著。
基线血压测量次数有限的二次分析以及关于透析处方的信息有限。
约10%的新发患者在HD期间SBP升高超过10 mmHg，尽管HD期间SBP升高与2年生存率降低相关，但这些发现仅限于透析前SBP低于120 mmHg的患者。
