Department of Medicine/Nephrology, San Francisco VA Medical Center/University of California, San Francisco, CA, USA.
Nephrol Dial Transplant. 2013 Oct;28(10):2580-5. doi: 10.1093/ndt/gft097. Epub 2013 Jun 5.
Post-dialysis fatigue (PDF) is a common, debilitating symptom that remains poorly understood. Cardiac wall motion abnormalities (WMAs) may worsen during dialysis, but it is unknown whether WMA are associated with PDF.
Forty patients were recruited from University of California San Francisco-affiliated dialysis units between January 2010 and February 2011. Participants underwent echocardiograms before and during the last hour of 79 dialysis sessions. Myocardial segments were graded 1-4 by a blinded reviewer, with four representing the worst WMA, and the segmental scores were summed for each echocardiogram. Patients completed questionnaires about their symptoms. Severe PDF (defined as lasting >2 h after dialysis) was analysed using a generalized linear model with candidate predictors including anemia, intradialytic hemodynamics and cardiac function.
Forty-four percent of patients with worsened WMA (n=9) had severe PDF, compared with 13% of patients with improved or unchanged WMA (P = 0.04). A one-point increase in the WMA score during dialysis was associated with a 10% higher RR of severe PDF [RR: 1.1, 95% CI (1.1, 1.2), P < 0.001]. After multivariable adjustment, every point increase in the WMA score was associated with a 2-fold higher risk of severe PDF [RR: 1.9, 95% CI (1.4, 2.6), P < 0.001]. History of depression was associated with severe PDF after adjustment for demographics and comorbidities [RR: 3.4, 95% CI (1.3, 9), P = 0.01], but anemia, hemodynamics and other parameters of cardiac function were not.
Although cross-sectional, these results suggest that some patients may experience severe PDF as a symptom of cardiac ischemia occurring during dialysis.
透析后疲劳（PDF）是一种常见的、使人虚弱的症状，但仍未被充分了解。心脏壁运动异常（WMAs）在透析过程中可能会恶化，但尚不清楚 WMA 是否与 PDF 有关。
2010 年 1 月至 2011 年 2 月期间，我们从加利福尼亚大学旧金山附属医院的透析单位招募了 40 名患者。参与者在 79 次透析疗程的最后一小时内进行了超声心动图检查。一名盲法评审员对心肌节段进行 1-4 级评分，其中 4 级代表最严重的 WMAs，并且对每个超声心动图的节段评分进行了求和。患者完成了关于其症状的问卷。使用广义线性模型分析严重 PDF（定义为透析后持续 >2 小时），候选预测因子包括贫血、透析期间血液动力学和心脏功能。
WMAs 恶化的患者中有 44%（n=9）出现严重 PDF，而 WMAs 改善或未改变的患者中仅有 13%（P=0.04）。透析期间 WMAs 评分增加 1 分，严重 PDF 的 RR 增加 10%[RR：1.1，95%CI（1.1，1.2），P<0.001]。经多变量调整后，WMAs 评分每增加 1 分，严重 PDF 的风险增加 2 倍[RR：1.9，95%CI（1.4，2.6），P<0.001]。在调整人口统计学和合并症后，抑郁史与严重 PDF 相关[RR：3.4，95%CI（1.3，9），P=0.01]，但贫血、血液动力学和其他心脏功能参数与严重 PDF 无关。
尽管这些结果是横断面的，但它们表明一些患者可能会出现严重 PDF，这是透析期间发生心脏缺血的症状。
