维持性血液透析患者透析中高血压的发生频率及其短期临床结局。
Intradialytic Hypertension Frequency and Short-Term Clinical Outcomes Among Individuals Receiving Maintenance Hemodialysis.
机构信息
University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA.
Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
出版信息
Am J Hypertens. 2018 Feb 9;31(3):329-339. doi: 10.1093/ajh/hpx186.
BACKGROUND
Intradialytic hypertension occurs in 5-20% of hemodialysis treatments. Observational data support an association between intradialytic hypertension and long-term mortality. However, the short-term consequences of recurrent intradialytic hypertension are unknown.
METHODS
Data were taken from a cohort of prevalent hemodialysis patients receiving treatment at a large United States dialysis organization on 1 January 2010. A retrospective cohort design with a 180-day baseline, 30-day exposure assessment, and 30-day follow-up period was used to estimate the associations between intradialytic hypertension frequency and 30-day outcomes. Intradialytic hypertension frequency was defined as the proportion of exposure period hemodialysis treatments with a predialysis to postdialysis systolic blood pressure rise >0 mm Hg. Multivariable Cox proportional hazards regression, adjusted for baseline clinical, laboratory, and dialysis treatment covariates, was used to estimate hazard ratios and 95% confidence intervals.
RESULTS
Of the 37,094 study patients, 5,242 (14.1%), 17,965 (48.4%), 10,821 (29.2%), 3,066 (8.3%) had intradialytic hypertension in 0%, 1-32%, 33-66%, and ≥67% of exposure period treatments, respectively. More frequent intradialytic hypertension was associated with incremental increases in 30-day mortality and hospitalizations. Patients with intradialytic hypertension in ≥67% (vs. 0%) of exposure period treatments had the highest risk of all-cause death, hazard ratio [95% confidence interval]: 2.57 [1.68, 3.94]; cardiovascular (CV) death, 3.68 [1.89, 7.15]; all-cause hospitalizations, 1.42 [1.26, 1.62]; CV hospitalizations, 1.71 [1.36, 2.15]; and volume-related hospitalizations, 2.25 [1.25, 4.04].
CONCLUSIONS
Among prevalent hemodialysis patients, more frequent intradialytic hypertension was incrementally associated with increased 30-day morbidity and mortality. Intradialytic hypertension may be an important short-term risk marker in the hemodialysis population.
背景
透析中高血压发生于 5-20%的血液透析治疗中。观察性数据支持透析中高血压与长期死亡率之间存在关联。然而，反复透析中高血压的短期后果尚不清楚。
方法
数据来自于 2010 年 1 月 1 日在美国一家大型透析机构接受治疗的一般透析患者队列。采用回顾性队列设计，基线为 180 天，暴露评估期为 30 天，随访期为 30 天，以评估透析中高血压频率与 30 天结局之间的关系。透析中高血压频率定义为暴露期血液透析治疗中，透析前至透析后收缩压升高超过 0mmHg 的比例。采用多变量 Cox 比例风险回归，根据基线临床、实验室和透析治疗协变量进行调整，以估计风险比和 95%置信区间。
结果
在 37094 例研究患者中，分别有 5242 例（14.1%）、17965 例（48.4%）、10821 例（29.2%）和 3066 例（8.3%）在 0%、1-32%、33-66%和≥67%的暴露期治疗中发生透析中高血压。透析中高血压发生频率越高，30 天死亡率和住院率增加。在≥67%（与 0%）暴露期治疗中发生透析中高血压的患者全因死亡风险最高，风险比（95%置信区间）为 2.57（1.68，3.94）；心血管（CV）死亡为 3.68（1.89，7.15）；全因住院为 1.42（1.26，1.62）；CV 住院为 1.71（1.36，2.15）；容量相关住院为 2.25（1.25，4.04）。
结论
在一般血液透析患者中，透析中高血压发生频率越高，30 天发病率和死亡率增加幅度越大。透析中高血压可能是血液透析人群中一个重要的短期风险标志物。
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