Kim Esther D, Sozio Stephen M, Estrella Michelle M, Jaar Bernard G, Shafi Tariq, Meoni Lucy A, Kao Wen Hong Linda, Lima Joao A C, Parekh Rulan S
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
BMC Nephrol. 2015 Aug 7;16:131. doi: 10.1186/s12882-015-0131-4.
Higher left ventricular mass (LV) strongly predicts cardiovascular mortality in hemodialysis patients. Although several parameters of preload and afterload have been associated with higher LV mass, whether these parameters independently predict LV mass, remains unclear.
This study examined a cohort of 391 adults with incident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study. The main exposures were systolic and diastolic blood pressure (BP), pulse pressure, arterial stiffness by pulse wave velocity (PWV), volume status estimated by pulmonary pressures using echocardiogram and intradialytic weight gain. The primary outcome was baseline left ventricular mass index (LVMI).
Each systolic, diastolic blood, and pulse pressure measurement was significantly associated with LVMI by linear regression regardless of dialysis unit BP or non-dialysis day BP measurements. Adjusting for cardiovascular confounders, every 10 mmHg increase in systolic or diastolic BP was significantly associated with higher LVMI (SBP β = 7.26, 95 % CI: 4.30, 10.23; DBP β = 10.05, 95 % CI: 5.06, 15.04), and increased pulse pressure was also associated with higher LVMI (β = 0.71, 95 % CI: 0.29, 1.13). Intradialytic weight gain was also associated with higher LVMI but attenuated effects after adjustment (β = 3.25, 95 % CI: 0.67, 5.83). PWV and pulmonary pressures were not associated with LVMI after multivariable adjustment (β = 0.19, 95 % CI: -1.14, 1.79; and β = 0.10, 95 % CI: -0.51, 0.70, respectively). Simultaneously adjusting for all main exposures demonstrated that higher BP was independently associated with higher LVMI (SBP β = 5.64, 95 % CI: 2.78, 8.49; DBP β = 7.29, 95 % CI: 2.26, 12.31, for every 10 mmHg increase in BP).
Among a younger and incident hemodialysis population, higher systolic, diastolic, or pulse pressure, regardless of timing with dialysis, is most associated with higher LV mass. Future studies should consider the use of various BP measures in examining the impact of BP on LVM and cardiovascular disease. Findings from such studies could suggest that high BP should be more aggressively treated to promote LVH regression in incident hemodialysis patients.
左心室质量（LV）较高强烈预示着血液透析患者的心血管死亡率。尽管前负荷和后负荷的几个参数与较高的左心室质量相关，但这些参数是否能独立预测左心室质量仍不清楚。
本研究调查了391例初次接受血液透析的成年患者，这些患者均纳入了终末期肾病心律失常和心血管风险预测（PACE）研究。主要暴露因素为收缩压和舒张压（BP）、脉压、通过脉搏波速度（PWV）评估的动脉僵硬度、使用超声心动图通过肺压评估的容量状态以及透析期间体重增加。主要结局为基线左心室质量指数（LVMI）。
通过线性回归分析，无论透析单元血压或非透析日血压测量值如何，每次收缩压、舒张压和脉压测量值均与LVMI显著相关。在调整心血管混杂因素后，收缩压或舒张压每升高10 mmHg均与较高的LVMI显著相关（收缩压β = 7.26，95%CI：4.30，10.23；舒张压β = 10.05，95%CI：5.06，15.04），脉压升高也与较高的LVMI相关（β = 0.71，95%CI：0.29，1.13）。透析期间体重增加也与较高的LVMI相关，但调整后效应减弱（β = 3.25，95%CI：0.67，5.83）。多变量调整后，PWV和肺压与LVMI无关（β = 0.19，95%CI：-1.14，1.79；β = 0.10，95%CI：-0.51，0.70）。同时调整所有主要暴露因素表明，较高的血压与较高的LVMI独立相关（血压每升高10 mmHg，收缩压β = 5.64，95%CI：2.78，8.49；舒张压β = 7.29，95%CI：2.26，12.31）。
在较年轻的初次血液透析人群中，无论透析时间如何，较高的收缩压、舒张压或脉压与较高的左心室质量最相关。未来研究在探讨血压对左心室质量和心血管疾病的影响时应考虑使用各种血压测量方法。此类研究结果可能表明，应更积极地治疗高血压，以促进初次血液透析患者左心室肥厚的逆转。
