Division of Nephrology, Department of Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA.
Am J Kidney Dis. 2011 Nov;58(5):794-803. doi: 10.1053/j.ajkd.2011.05.028. Epub 2011 Jul 31.
Little is known about the behavior of systolic blood pressure (SBP) during hemodialysis.
Prospective observational cohort.
SETTING & PARTICIPANTS: 218 prevalent hemodialysis patients treated at 5 participating DaVita Dialysis units.
Clinical variables that may plausibly influence the behavior of SBP during the course of hemodialysis sessions.
SBP at the onset of dialysis and its rate of change (slope) over the first 25% and latter 75% of the treatment interval.
SBPs measured and recorded per clinical protocol during the first 30 days of study (median, 11 treatments/patient; SBP measured at 30-minute intervals).
Intradialytic SBP behavior is well characterized by a 2-slope linear spline model, which describes SBP at time zero, a rapid decrease during the first 25% of the treatment (early), and a more gradual decrease thereafter (late). Higher ultrafiltration volume and rate each are associated with greater SBP at the start of dialysis and more rapid early and late SBP decreases. Use of a higher number of antihypertensives was associated with greater time zero SBP. Calcium acetate use is associated with high SBP at the start of hemodialysis and a more pronounced decrease during the early and late parts of treatment.
Over-representation of blacks and patients with congestive heart failure; observational design; use of clinically measured blood pressures.
Intradialytic SBP can be characterized using 3 parameters: value at the start of dialysis and slopes during the first 25% and latter 75% of treatment. Practices related to fluid management, antihypertensive use, and metabolic bone disease control are associated with blood pressure behavior during dialysis. Further work is needed to confirm findings and measure associations between various aspects of intradialytic blood pressure behavior and clinical outcomes.
关于血液透析过程中收缩压（SBP）的变化情况知之甚少。
前瞻性观察队列研究。
在参与研究的 5 家 DaVita 透析中心接受治疗的 218 例持续性血液透析患者。
可能影响血液透析过程中 SBP 变化的临床变量。
透析开始时的 SBP 及其在治疗前 25%和后 75%时间段内的变化率（斜率）。
根据临床方案在研究开始后的第 30 天内测量并记录 SBPs（中位数，11 次治疗/患者；每 30 分钟测量一次 SBP）。
透析期间 SBP 的行为可以通过 2 个斜率线性样条模型很好地描述，该模型描述了时间为零的 SBP，治疗前 25%期间快速下降（早期），此后下降速度更慢（晚期）。超滤量和超滤率越高，透析开始时的 SBP 越高，早期和晚期 SBP 下降速度越快。使用更多种类的降压药与更高的初始 SBP 相关。醋酸钙的使用与血液透析开始时的 SBP 较高和治疗早期和晚期的 SBP 明显下降有关。
黑人患者和充血性心力衰竭患者人数过多；观察性设计；使用临床测量的血压。
可以使用 3 个参数来描述透析过程中的 SBP：透析开始时的数值和治疗前 25%和后 75%时间段内的斜率。与液体管理、降压药使用和代谢性骨病控制相关的实践与透析过程中的血压变化有关。需要进一步的工作来确认研究结果，并测量透析期间各种血压变化与临床结果之间的关联。
