Inaguma Daijo, Koide Shigehisa, Takahashi Kazuo, Hayashi Hiroki, Hasegawa Midori, Yuzawa Yukio
Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
The Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP) Group.
Nephrology (Carlton). 2018 May;23(5):461-468. doi: 10.1111/nep.13048.
Some observational studies of the general population showed that resting heart rate was associated with mortality. However, the relationship was unclear in dialysis patients.
The study was a multicentre prospective cohort analysis including 1102 patients. Patients were classified into four groups based on resting heart rate just before starting the first dialysis session: <60/min; 60-79/min; 80-100/min; and ≥101/min. All-cause mortality, cardiovascular (CV) related mortality, and incidences of CV events after dialysis initiation were compared using the log-rank test. All-cause mortality rates for patients with heart rates <60, 60-79, and ≥101/min were compared to those for patients with heart rates 80-100/min, using multivariate Cox proportional hazard regression analysis. Moreover, we compared the outcomes among patients without use of β-blocker or heart failure symptom at the first dialysis session.
Significant differences were observed in the all-cause mortality rates among the four groups (P = 0.007). Multivariate analysis revealed that all-cause mortality was significantly higher in patients with heart rate ≥ 101/min than in patients with heart rate 80-100/min (hazard ratio [HR] = 2.30, 95% confidence interval [CI]: 1.25-4.23). Subgroup analysis showed that among patients without use of b-blocker or heart failure symptom, all-cause mortality rates for those with heart rates ≥101/min were significantly higher than in patients with heart rate 80-100/min (HR = 2.98, 95% CI: 1.51-5.88, HR = 3.65, 95% CI: 1.59-8.36, respectively).
The resting heart rate just before starting the first dialysis session was associated with all-cause mortality after dialysis initiation.
一些针对普通人群的观察性研究表明静息心率与死亡率相关。然而，在透析患者中这种关系尚不清楚。
本研究为多中心前瞻性队列分析，纳入1102例患者。根据首次透析 session 开始前的静息心率将患者分为四组：<60次/分钟；60 - 79次/分钟；80 - 100次/分钟；≥101次/分钟。使用对数秩检验比较透析开始后的全因死亡率、心血管（CV）相关死亡率以及CV事件发生率。采用多变量Cox比例风险回归分析比较心率<60、60 - 79以及≥101次/分钟患者的全因死亡率与心率80 - 100次/分钟患者的全因死亡率。此外，我们比较了首次透析 session 时未使用β受体阻滞剂或无心力衰竭症状患者的结局。
四组患者的全因死亡率存在显著差异（P = 0.007）。多变量分析显示，心率≥101次/分钟患者的全因死亡率显著高于心率80 - 100次/分钟患者（风险比[HR] = 2.30，95%置信区间[CI]：1.25 - 4.23）。亚组分析表明，在未使用β受体阻滞剂或无心力衰竭症状的患者中，心率≥101次/分钟患者的全因死亡率显著高于心率80 - 100次/分钟患者（HR分别为2.98，95% CI：1.51 - 5.88；HR = 3.65，95% CI：1.59 - 8.36）。
首次透析 session 开始前的静息心率与透析开始后的全因死亡率相关。
Zotero 插件