Kumar Sanjeev, Khosravi Maryam, Massart Annick, Potluri Madhu, Davenport Andrew
UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London - UK.
Int J Artif Organs. 2014 Jan;37(1):21-8. doi: 10.5301/ijao.5000290. Epub 2014 Jan 20.
A fall in blood pressure is the most common complication of outpatient hemodialysis. Several factors have been implicated, including serum sodium to dialysate gradient, ultrafiltration rate, and the amount of fluid to be removed during dialysis.
We prospectively audited 400 adult patients attending for their routine midweek hemodialysis session, and recorded changes in mean arterial blood pressure (MAP).
Mean age 58.4 ± 16.6 years, 60.9% male, 30.7% diabetic, 36.8% Caucasoid, single pool Kt/V 1.57 ± 0.4, and median percentage change in MAP -6.7% (-14.1 to + 2.8). The percentage fall in MAP was greatest for those starting with higher MAPs (β 0.448 , F 67.5, p<0.001), greater serum sodium to dialysate sodium gradient (β 0.676, F 5.59, p = 0.019), and age (β 0.163, F 5.15, p = 0.024). In addition, the percentage fall in MAP was greater in those with the lowest segmental extracellular water/total body water (ECW/TBW) ratios in the right arm prior to dialysis (β -477.5, F 7.11, p = 0.008).
Falls in blood pressure are common during dialysis, and greater for those starting dialysis with the highest systolic pressures, greater dialysate to serum sodium concentration gradient, and also those with the least ECW in the arm. As such, segmental bioimpedance may be useful in highlighting patients at greatest risk for a fall in blood pressure with dialysis.
血压下降是门诊血液透析最常见的并发症。多种因素与之相关，包括血清钠与透析液的梯度、超滤率以及透析过程中要清除的液体量。
我们前瞻性地对400名成年患者进行了常规周中血液透析治疗的审核，并记录了平均动脉血压（MAP）的变化。
平均年龄58.4±16.6岁，男性占60.9%，糖尿病患者占30.7%，白种人占36.8%，单池Kt/V为1.57±0.4，MAP的中位数变化为-6.7%（-14.1至+2.8）。MAP下降百分比在起始MAP较高者中最大（β0.448，F 67.5，p<0.001），血清钠与透析液钠梯度较大者中也较大（β0.676，F 5.59，p = 0.019），以及年龄较大者中较大（β0.163，F 5.15，p = 0.024）。此外，透析前右臂节段性细胞外液/总体液（ECW/TBW）比值最低者的MAP下降百分比更大（β -477.5，F 7.11，p = 0.008）。
透析过程中血压下降很常见，起始透析时收缩压最高者、透析液与血清钠浓度梯度较大者以及手臂中ECW最少者下降幅度更大。因此，节段性生物电阻抗可能有助于识别透析时血压下降风险最大的患者。
