Jung Jong Hwan, Chae Yoon Jung, Lee Dong Hwan, Cho Young I, Ko Mi Mi, Park Sung Kwang, Kim Won
Department of Internal Medicine, Divsion of Nephrology, Wonkwang University College of Medicine, Iksan, Republic of Korea.
College of Nursing, Chonbuk National University, Jeonju, Republic of Korea.
Clin Hemorheol Microcirc. 2017;65(3):285-297. doi: 10.3233/CH-16183.
Whole blood viscosity (WBV) plays a role in hemorheology and is determined by many factors such as red blood cell factors, plasma protein and blood volume. As WBV changes during hemodialysis, mortality may be due to changes in WBV in patients on hemodialysis. However, there are few prospective data on the relationship between changes in WBV and overall mortality in dialysis patients. We tried to investigate the correlations between values of WBV at variable shear rates before and after hemodialysis and overall or atherosclerosis-related mortality in patients with end-stage kidney disease.Forty-three patients receiving hemodialysis were enrolled in this study. In this 5.8-year prospective observational study, analyses of the effects of WBV at shear rates of 300 s-1 (systolic WBV; SBV), 5 s-1 (diastolic WBV5; DBV5), and 1 s-1 (diastolic WBV1; DBV1) during dialysis on all-cause and atherosclerotic mortality was performed.Among a total of 43 patients, 27 (62.7%) died over the course of the study. Thirteen deaths were caused by atherosclerotic events. A high degree of change in WBV at shear rates of 300 s-1 and 5 s-1 during hemodialysis (ΔSBV, ΔDBV5) was positively correlated with overall mortality (HR = 4.688, 95% confidence interval [CI], 1.269-17.319, p = 0.020; HR = 3.941, 95% CI, 1.057-14.701, p = 0.041, respectively). A high degree of change in diastolic blood pressure (ΔDBP) during hemodialysis was also positively correlated with overall mortality (HR = 3.035, 95% CI, 1.039-8.867, p = 0.042). However, comparative analysis between WBV at shear rates of 300 s-1, 5 s-1, and 1 s-1 and overall mortality did not reveal any significant relationships. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from a high degree of change of WBV at shear rates of 300 s-1, compared to those from the moderate or low degree of changes of WBV at shear rates of 300 s-1 (p = 0.020, log-rank test). Survival rate in high ΔDBP was lower than that of moderate or low ΔDBP group in Kaplan-Meier survival analysis (p = 0.004, log-rank test).Our data showed that a high degree of change in WBV at variable shear rates during hemodialysis might impact overall survival in patients with end-stage kidney disease. However, large-scale studies to evaluate the relationship of WBV with overall mortality and atherosclerotic mortality will be needed.
全血粘度（WBV）在血液流变学中起作用，并且由许多因素决定，如红细胞因素、血浆蛋白和血容量。由于血液透析期间WBV会发生变化，死亡率可能与血液透析患者的WBV变化有关。然而，关于WBV变化与透析患者全因死亡率之间关系的前瞻性数据很少。我们试图研究血液透析前后不同剪切速率下WBV值与终末期肾病患者的全因或动脉粥样硬化相关死亡率之间的相关性。
本研究纳入了43例接受血液透析的患者。在这项为期5.8年的前瞻性观察研究中，分析了透析期间剪切速率为300 s-1（收缩期WBV；SBV）、5 s-1（舒张期WBV5；DBV5）和1 s-1（舒张期WBV1；DBV1）时WBV对全因和动脉粥样硬化死亡率的影响。
在总共43例患者中，27例（62.7%）在研究过程中死亡。13例死亡由动脉粥样硬化事件引起。血液透析期间剪切速率为300 s-1和5 s-1时WBV的高度变化（ΔSBV，ΔDBV5）与全因死亡率呈正相关（HR = 4.688，95%置信区间[CI]，1.269 - 17.319，p = 0.020；HR = 3.941，95% CI，1.057 - 14.701，p = 0.041）。血液透析期间舒张压的高度变化（ΔDBP）也与全因死亡率呈正相关（HR = 3.035，95% CI，1.039 - 8.867，p = 0.042）。然而，剪切速率为300 s-1、5 s-1和1 s-1时WBV与全因死亡率之间的比较分析未发现任何显著关系。Kaplan-Meier分析显示，与剪切速率为300 s-1时WBV变化程度为中度或低度的患者相比，剪切速率为300 s-1时WBV变化程度高的患者全因死亡率显著更高（p = 0.020，对数秩检验）。在Kaplan-Meier生存分析中，高ΔDBP组的生存率低于中度或低ΔDBP组（p = 0.004，对数秩检验）。
我们的数据表明，血液透析期间不同剪切速率下WBV的高度变化可能会影响终末期肾病患者的总体生存。然而，需要大规模研究来评估WBV与全因死亡率和动脉粥样硬化死亡率之间的关系。
