aTherapeutiki Hemodialysis Unit bDepartment of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki cPieria Hemodialysis Unit, Katerini dHemodialysis Unit, Achillopouleion General Hospital, Volos eSection of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece fDepartment of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain gDepartment of Cardiovascular, Neural and Metabolic Sciences, IRCCS S. Luca Hospital, Istituto Auxologico Italiano hDepartment of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
J Hypertens. 2017 Dec;35(12):2517-2526. doi: 10.1097/HJH.0000000000001478.
Patients with end-stage renal-disease under hemodialysis have increased cardiovascular risk and experience severe blood pressure (BP) fluctuations during the dialysis session and the subsequent interdialytic period. BP variability (BPV) may be an additional risk factor for cardiovascular events and preliminary data suggest increased BPV with advancing stages of chronic kidney disease. This is the first study to examine BPV during the whole intradialytic and interdialytic period in hemodialysis patients with ambulatory BP monitoring.
A total of 160 patients receiving maintenance hemodialysis had 48-h ambulatory BP monitoring with the Mobil-O-Graph device during a regular dialysis session and the subsequent interdialytic interval. Brachial and aortic BPV were calculated with validated formulas and were compared between Days 1 and 2 of the interdialytic period (44-h), Days 1 and 2 of the total 48-h interval (including the dialysis session), and between the two respective daytime periods and night-time periods.
All brachial SBPV indices [SD: 14.75 ± 4.38 vs. 15.91 ± 4.41, P = 0.001; weighted SD: 13.80 ± 4.00 vs. 14.89 ± 3.90, P < 0.001; coefficient of variation (CV): 11.34 ± 2.91 vs. 11.93 ± 2.94, P = 0.011; average real variability (ARV): 11.38 ± 3.44 vs. 12.32 ± 3.65, P < 0.001)] were increasing from Days 1 to 2 of the 44-h interdialytic period. Similarly, all indexes of DBPV were significantly increased in Day 2, except for CV. Aortic SBPV and DBPV indices displayed a similar pattern. Furthermore, all studied brachial SBPV and DBPV indexes were also lower during daytimes 1 than 2 (systolic ARV 11.56 ± 3.98 vs. 12.44 ± 4.03, P = 0.002); systolic ARV was lower in night-time 1 compared with night-time 2 (11.20 ± 5.09 vs. 12.18 ± 4.66, P = 0.045). In multivariate regression analysis prehemodialysis SBP, age and diabetes were independently associated with increased SBP ARV.
BPV is increased in interdialytic Day 2 compared with Day 1 in hemodialysis patients; this could be another mechanism involved in the complex cardiovascular pathophysiology and increased cardiovascular mortality of these individuals.
接受血液透析的终末期肾病患者心血管风险增加，在透析期间和随后的无透析期会经历严重的血压（BP）波动。BP 变异性（BPV）可能是心血管事件的另一个危险因素，初步数据表明慢性肾脏病进展阶段的 BPV 增加。这是第一项使用动态血压监测检查血液透析患者整个透析内和无透析期 BPV 的研究。
共有 160 名接受维持性血液透析的患者在常规透析期间和随后的无透析间隔期间使用 Mobil-O-Graph 设备进行了 48 小时的动态血压监测。使用验证公式计算肱动脉和主动脉 BPV，并在无透析间隔的第 1 天和第 2 天（44 小时）、48 小时总间隔的第 1 天和第 2 天（包括透析期）以及两个相应的白天和夜间时间段之间进行比较。
所有肱动脉 SBPV 指数[标准差：14.75±4.38 与 15.91±4.41，P=0.001；加权标准差：13.80±4.00 与 14.89±3.90，P<0.001；变异系数（CV）：11.34±2.91 与 11.93±2.94，P=0.011；平均真实变异性（ARV）：11.38±3.44 与 12.32±3.65，P<0.001]从无透析间隔的第 1 天到第 2 天逐渐增加。同样，除 CV 外，DBPV 的所有指数在第 2 天均显著增加。主动脉 SBPV 和 DBPV 指数表现出相似的模式。此外，所有研究的肱动脉 SBPV 和 DBPV 指数在白天 1 时也低于白天 2（收缩压 ARV 11.56±3.98 与 12.44±4.03，P=0.002）；夜间 1 时的收缩压 ARV 低于夜间 2（11.20±5.09 与 12.18±4.66，P=0.045）。多元回归分析显示，透析前 SBP、年龄和糖尿病与 SBP ARV 增加独立相关。
与血液透析患者无透析日 1 相比，无透析日 2 的 BPV 增加；这可能是这些个体复杂心血管病理生理学和心血管死亡率增加的另一个机制。
