透析前低血压并非长期血液透析患者死亡率的预测因素：来自单中心观察性研究的见解。

Predialysis hypotension is not a predictor for mortality in long-term hemodialysis patients: insight from a single-center observational study.

作者信息

Huang Wen-Hung, Hsu Ching-Wei, Hu Ching-Chih, Yen Tzung-Hai, Weng Cheng-Hao

机构信息

Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Gueishan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.

Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China.

出版信息

Ther Clin Risk Manag. 2016 Aug 24;12:1285-92. doi: 10.2147/TCRM.S111635. eCollection 2016.

DOI:10.2147/TCRM.S111635

PMID:27601912

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5005003/

Abstract

INTRODUCTION

Predialysis hypotension has been noted to be a predictor of mortality in hemodialysis (HD) patients. Previous studies evaluating the impact of predialysis hypotension on the mortality of HD patients did not exclude patients with diabetes mellitus (DM) or cardiovascular disease.

METHODS

Eight hundred and sixty-six patients on maintenance HD were recruited. Clinical parameters were recorded and subjected to the analysis of predictors of predialysis hypotension and mortality.

RESULTS

Multivariate logistic regression analyses indicated that DM (odds ratio [OR]: 0.439, P=0.002), hypertension history (OR: 0.634, P=0.022), Kt/V Daugirdas (OR: 2.545, P=0.001), anuria (OR: 2.313, P=0.002), serum phosphate (OR: 0.833, P=0.010), and serum triglyceride (OR: 1.002, P=0.012) were associated with predialysis hypotension. Multivariate Cox regression analysis showed that age (P<0.001), male sex (P=0.029), anuria (P=0.004), and DM (P=0.011) were associated with higher probability of 24- and 36-month mortality. Predialysis hypotension was not associated with higher probability of 12-, 24-, and 36-month mortality.

CONCLUSION

Predialysis hypotension is not a predictor of 12-, 24-, and 36-month survival in patients without DM and with higher dialysis adequacy.

摘要

引言

透析前低血压被认为是血液透析（HD）患者死亡率的一个预测指标。以往评估透析前低血压对HD患者死亡率影响的研究未排除糖尿病（DM）或心血管疾病患者。

方法

招募了866例维持性HD患者。记录临床参数，并对透析前低血压和死亡率的预测因素进行分析。

结果

多因素逻辑回归分析表明，DM（比值比[OR]：0.439，P = 0.002）、高血压病史（OR：0.634，P = 0.022）、Kt/V达吉尔达斯（OR：2.545，P = 0.001）、无尿（OR：2.313，P = 0.002）、血清磷酸盐（OR：0.833，P = 0.010）和血清甘油三酯（OR：1.002，P = 0.012）与透析前低血压相关。多因素Cox回归分析显示，年龄（P < 0.001）、男性（P = 0.029）、无尿（P = 0.004）和DM（P = 0.011）与24个月和36个月死亡率的较高概率相关。透析前低血压与12个月、24个月和36个月死亡率的较高概率无关。