Sands Jeffrey J, Usvyat Len A, Sullivan Terry, Segal Jonathan H, Zabetakis Paul, Kotanko Peter, Maddux Franklin W, Diaz-Buxo Jose A
Fresenius Medical Care North America, Waltham, Massachusetts, USA.
Hemodial Int. 2014 Apr;18(2):415-22. doi: 10.1111/hdi.12138. Epub 2014 Jan 27.
Intradialytic hypotension (IH) is a frequent complication of hemodialysis (HD) and is associated with increased patient mortality and cardiovascular events. We studied IH to determine its variability, correlates, and clinical impact in 13 outpatient HD facilities. Blood pressure was captured by machine download. IH was defined as >30 mmHg decrease in systolic blood pressure to <90 mmHg. Risk factors were assessed by logistic regression and hospitalization by Poisson regression. Time to death and first hospitalization were assessed using Kaplan-Meier analysis in patients completing >20 HD treatments. We studied IH in 44,801 treatments (Tx) in 1137 patients. IH was frequent (17.2% of treatments) and highly variable by patient (0-100% Tx) and dialysis facility (11.1-25.8% Tx). 25.1% of patients had no IH (0% Tx) and 16.2% had IH on >35% Tx. Increased IH frequency was associated with age, female gender, diabetes, Hispanic origin, longer end stage renal disease vintage, higher body mass index, higher ultrafiltration volume, the second and third weekly Tx, lower pre-HD systolic blood pressure, higher difference between prescribed and achieved post-HD weight, and higher dialysate temperature. Dialysis facility was an independent predictor of IH frequency. Patients with >35% IH treatments had poorer survival (P = 0.036), and more frequent and longer hospitalization (P = 0.04, P = 0.002, respectively) than patients without IH. In conclusion, IH frequency was highly variable, associated with individual facilities, patient and treatment characteristics, and correlated with mortality and hospitalization. Identifying practice patterns associated with IH coupled with routine reporting of IH will facilitate medical management and may result in the prevention of IH, decreased mortality, and decreased hospitalization.
透析中低血压（IH）是血液透析（HD）的常见并发症，与患者死亡率增加和心血管事件相关。我们在13个门诊血液透析机构研究了IH，以确定其变异性、相关因素及临床影响。通过机器下载获取血压数据。IH定义为收缩压下降>30 mmHg至<90 mmHg。通过逻辑回归评估危险因素，通过泊松回归评估住院情况。对完成>20次血液透析治疗的患者，使用Kaplan-Meier分析评估死亡时间和首次住院时间。我们对1137例患者的44801次治疗（Tx）进行了IH研究。IH很常见（占治疗的17.2%），且在患者个体（0 - 100% Tx）和透析机构（11.1 - 25.8% Tx）之间差异很大。25.1%的患者无IH（0% Tx），16.2%的患者>35% Tx出现IH。IH频率增加与年龄、女性、糖尿病、西班牙裔血统、终末期肾病病程较长体质量指数较高、超滤量较高、每周第二次和第三次治疗、透析前收缩压较低、规定的透析后体重与实际透析后体重差异较大以及透析液温度较高相关。透析机构是IH频率的独立预测因素。与无IH的患者相比，IH治疗>35%的患者生存率较差（P = 0.036），住院更频繁且时间更长（分别为P = 0.04，P = 0.002）。总之，IH频率差异很大，与个体机构、患者及治疗特征相关，并与死亡率和住院情况相关。识别与IH相关的实践模式并常规报告IH将有助于医疗管理，并可能预防IH、降低死亡率及减少住院率。
