Eldehni Mohamed Tarek, Odudu Aghogho, McIntyre Christopher William
Division of Medical Sciences, School of Medicine, University of Nottingham, Derby, UK.
Nephron Clin Pract. 2014;128(1-2):39-44. doi: 10.1159/000359958. Epub 2014 Oct 23.
It is becoming recognised that the process of haemodialysis (HD) itself induces circulatory stress that could be implicated in the observed higher rate of end-organ damage. We aimed to study the haemodynamic performance during HD using the extrema points (EP) analysis model, and to examine the determinants of the model and its relation to circulatory stress.
63 incident HD patients were studied. Mean arterial blood pressure (MAP) EP frequencies and baroreflex sensitivity during HD were computed for continuous non-invasive haemodynamic monitoring. Pulse-wave velocity as a measure of arterial stiffness was performed. High-sensitivity troponin-T was also measured.
The time of each dialysis session was divided into four quarters. Repeated measures ANOVA of the MAP EP frequencies for all subjects during HD demonstrated a gradual significant increase reaching peak levels at the third quarter of dialysis time and remaining at that peak during the fourth quarter (F(3,171228) = 392.06, p < 0.001). In multivariate regression, lower baroreflex sensitivity was the only independent predictor of higher MAP EP frequencies (β = -0.642, p = 0.001, adjusted R(2) for the whole model = 0.385). In linear regression analysis, higher MAP EP frequencies were associated with higher troponin-T levels (β = 0.442, p = 0.002, R(2) = 0.19, B = 103.29, 95% CI 38.88-167.70).
The EP analysis model using MAP is a novel functional haemodynamic measure that can represent and quantify circulatory stress during HD. This measure seems to be determined by the integrity of the autonomic function in HD and could represent the link between circulatory stress and end-organ damage in HD patients.
人们逐渐认识到血液透析（HD）过程本身会引发循环应激，这可能与所观察到的较高终末器官损伤发生率有关。我们旨在使用极值点（EP）分析模型研究HD期间的血流动力学表现，并检查该模型的决定因素及其与循环应激的关系。
对63例初治HD患者进行研究。通过连续无创血流动力学监测计算HD期间的平均动脉血压（MAP）EP频率和压力反射敏感性。测量脉搏波速度作为动脉僵硬度的指标。还测量了高敏肌钙蛋白T。
每次透析疗程分为四个时段。对所有受试者HD期间的MAP EP频率进行重复测量方差分析，结果显示其逐渐显著增加，在透析时间的第三个时段达到峰值水平，并在第四个时段保持该峰值（F(3,171228) = 392.06，p < 0.001）。在多变量回归中，较低的压力反射敏感性是较高MAP EP频率的唯一独立预测因素（β = -0.642，p = 0.001，整个模型的调整R(2) = 0.385）。在线性回归分析中，较高的MAP EP频率与较高的肌钙蛋白T水平相关（β = 0.442，p = 0.002，R(2) = 0.19，B = 103.29，95% CI 38.88 - 167.70）。
使用MAP的EP分析模型是一种新型的功能性血流动力学测量方法，可代表和量化HD期间的循环应激。该测量方法似乎由HD中自主神经功能的完整性决定，并且可能代表HD患者循环应激与终末器官损伤之间的联系。
