Cho AJin, Lee Young-Ki, Oh Jieun, Yoon Jong-Woo, Shin Dong Ho, Jeon Hee Jung, Choi Myung-Jin, Noh Jung-Woo
Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University, Hallym University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
PLoS One. 2017 Oct 19;12(10):e0185846. doi: 10.1371/journal.pone.0185846. eCollection 2017.
Vascular calcification is associated with structural and functional abnormality of the heart and blood vessels. We investigated the relationship between intradialytic hypotension (IDH) and vascular calcification in hemodialysis (HD) patients, and their impacts on cardiovascular events (CVEs).
We enrolled 191 maintenance HD patients who underwent plain abdomen radiography for abdominal aortic calcification score (AACS). A nadir systolic blood pressure (BP) < 90 mm Hg or the requirement of bolus fluid administration was required to quantify the hypotension diagnosis. IDH was defined as > 2 hypotension episodes during 10 HD treatments.
Among the 191 patients, IDH occurred in 32. AACS was higher in the IDH group compared with the no-IDH group (8.4 ± 6.0 vs. 4.9 ± 5.2, respectively; P = 0.001). High AACS was an independent risk factor after adjustment for age, diabetes mellitus, ultrafiltration, diastolic BP, and calcium level (odds ratio (OR) = 1.09, 95% CI = 1.01-1.18; P = 0.03). Patients with both IDH and AACS ≧ 4 had the highest cumulative CVE rate (27.9%, P = 0.008) compared with 11.2%, 12.5%, and 6% for those with AACS ≧ 4 only, with IDH only, and neither, respectively. In multivariate analysis, the presence of both IDH and AACS ≧ 4 was a significant predictor of CVE (hazard ratio (HR) = 2.84, 95% CI = 1.04-7.74, P = 0.04).
IDH is associated with abdominal aortic calcification and is an independent risk factor for IDH. Both IDH and high AACS were significant predictors of CVE.
血管钙化与心脏和血管的结构及功能异常相关。我们研究了血液透析（HD）患者透析中低血压（IDH）与血管钙化之间的关系，以及它们对心血管事件（CVE）的影响。
我们纳入了191例接受维持性HD治疗且进行了腹部平片检查以评估腹主动脉钙化评分（AACS）的患者。以收缩压最低点（BP）<90 mmHg或需要推注液体来量化低血压诊断。IDH定义为在10次HD治疗中发生>2次低血压发作。
在191例患者中，32例发生IDH。IDH组的AACS高于无IDH组（分别为8.4±6.0和4.9±5.2；P = 0.001）。在调整年龄、糖尿病、超滤、舒张压和钙水平后，高AACS是独立危险因素（比值比（OR）= 1.09，95%可信区间（CI）= 1.01 - 1.18；P = 0.03）。与仅AACS≥4的患者（11.2%）、仅IDH的患者（12.5%）以及两者均无的患者（6%）相比，同时患有IDH且AACS≥4的患者累积CVE发生率最高（27.9%，P = 0.008）。在多变量分析中，同时存在IDH且AACS≥4是CVE的显著预测因素（风险比（HR）= 2.84，95%CI = 1.04 - 7.74，P = 0.04）。
IDH与腹主动脉钙化相关，是CVE的独立危险因素。IDH和高AACS均是CVE的显著预测因素。
