Kim Se Young, Hong Yu Ah, Yoon Hye Eun, Chang Yoon Kyung, Yang Chul Woo, Kim Suk Young, Hwang Hyeon Seok
Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.
Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.
Int J Cardiol. 2016 Aug 15;217:156-60. doi: 10.1016/j.ijcard.2016.04.183. Epub 2016 May 4.
Vascular calcification (VC) and intradialytic hypotension (IDH) indicate morphological and functional disorders of the cardiovascular system in hemodialysis (HD) patients. However, their relationship and combined effects on clinical outcomes remain undetermined.
HD patients (n=443) whose plain chest radiographs were examined for aortic arch VC were included. IDH was defined as nadir systolic blood pressure <90mmHg or need for bolus fluid. We investigated the relationship between VC and IDH, and their clinical significance for cardiovascular events (CVEs) and death.
VC was found in 57 HD patients (12.9%). IDH was more prevalent in patients with VC compared with those without VC (35.1% vs. 18.7%; P=0.004). VC was independently associated with a 2.12-fold increase in the risk of IDH (95% confidence interval [CI], 1.03-4.36). In multivariate analysis, compared with patients with neither VC nor IDH, the coexistence of VC and IDH was independently associated with death (hazard ratio [HR], 3.83; 95% CI, 1.62-9.08) and CVE (HR, 3.77; 95% CI, 1.53-9.33), whereas VC or IDH alone was not. Patients with both VC and IDH had the highest risk for a composite event (HR, 3.56; 95% CI, 1.79-7.08). Significant synergistic interaction was observed between VC and IDH (P for interaction=0.009).
VC was independently associated with IDH. Coexistence of VC and IDH was associated with higher risk of death and CVEs than either factor alone. There was a synergistic interaction between VC and IDH for the risk of a composite event.
血管钙化（VC）和透析中低血压（IDH）表明血液透析（HD）患者心血管系统存在形态和功能紊乱。然而，它们之间的关系以及对临床结局的联合影响仍未确定。
纳入443例接受胸部X线平片检查主动脉弓VC的HD患者。IDH定义为收缩压最低点<90mmHg或需要推注液体。我们研究了VC与IDH之间的关系及其对心血管事件（CVE）和死亡的临床意义。
57例HD患者（12.9%）发现有VC。与无VC的患者相比，有VC的患者IDH更常见（35.1%对18.7%；P=0.004）。VC与IDH风险增加2.12倍独立相关（95%置信区间[CI]，1.03 - 4.36）。在多变量分析中，与既无VC也无IDH的患者相比，VC和IDH共存与死亡（风险比[HR]，3.83；95%CI，1.62 - 9.08）和CVE（HR，3.77；95%CI，1.53 - 9.33）独立相关，而单独的VC或IDH则不然。同时有VC和IDH的患者发生复合事件的风险最高（HR，3.56；95%CI，1.79 - 7.08）。在VC和IDH之间观察到显著的协同相互作用（相互作用P=0.009）。
VC与IDH独立相关。VC和IDH共存与单独任何一个因素相比，死亡和CVE风险更高。在复合事件风险方面，VC和IDH之间存在协同相互作用。
