Division of Nephrology, "A. Landolfi" Hospital, Solofra, Avellino, Italy.
J Nephrol. 2013 Jan-Feb;26(1):173-82. doi: 10.5301/jn.5000108.
Hemodialysis patients have a high cardiovascular mortality, and hypertension is the most prevalent treatable risk factor. We aimed to assess the predictive significance of dialysis-to-dialysis variability in blood pressure in hemodialysis patients.
We performed a historical cohort study in 1,088 prevalent hemodialysis patients, followed up for 5 years. The risk of cardiovascular death was determined in relation to dialysis-to-dialysis variability in blood pressure, maximum blood pressure and pulse pressure.
Variability in blood pressure was a predictor of cardiovascular death (hazard ratio [HR] = 1.242; 95% confidence interval [95% CI], 1.004-1.537; p=0.046). Also age (HR=1.021; 95% CI, 1.011-1.048; p=0.049), diabetes (HR=1.134; 95% CI, 1.128-1.451; p=0.035), creatinine (HR=0.837; 95% CI, 0.717-0.977; p=0.024) and albumin (HR=0.901; 95% CI, 0.821-0.924; p=0.022) influenced mortality. Maximum blood pressure and pulse pressure did not show any effect on cardiovascular death.
Dialysis-to-dialysis variability in blood pressure is a predictor of cardiovascular mortality in hemodialysis patients, and blood pressure variability may be used in managing hypertension and predicting outcomes in dialysis patients.
血液透析患者的心血管死亡率较高，高血压是最常见的可治疗的危险因素。我们旨在评估血液透析患者透析间血压变异性对心血管死亡的预测意义。
我们对 1088 例普通血液透析患者进行了历史队列研究，随访 5 年。心血管死亡的风险与血压、最大血压和脉压的透析间变异性相关。
血压变异性是心血管死亡的预测因子（风险比 [HR] = 1.242；95%置信区间 [95%CI]，1.004-1.537；p=0.046）。年龄（HR=1.021；95%CI，1.011-1.048；p=0.049）、糖尿病（HR=1.134；95%CI，1.128-1.451；p=0.035）、肌酐（HR=0.837；95%CI，0.717-0.977；p=0.024）和白蛋白（HR=0.901；95%CI，0.821-0.924；p=0.022）也影响死亡率。最大血压和脉压对心血管死亡没有影响。
血液透析患者透析间血压变异性是心血管死亡率的预测因子，血压变异性可用于高血压的管理和预测透析患者的结局。
