Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China.
J Hum Hypertens. 2019 Jan;33(1):41-49. doi: 10.1038/s41371-018-0103-9. Epub 2018 Sep 12.
Blood pressure (BP) management posed great challenge in hemodialysis (HD) population. We conducted a dose-response meta-analysis to investigate the quantitative features and the potential threshold effect of the associations between peridialysis BP levels and all-cause mortality risk in HD population. We searched all of the prospective cohort studies (published before 18 March 2017) on the associations between peridialysis BP levels and all-cause mortality risk. A total of 229,688 prevalent HD patients from 8 studies were included. Significant non-linear associations were noted between peridialytic BP levels and all-cause mortality risk. Significant increased risk of death was found in four peridialysis BP ranges, that is, low levels of predialysis SBP (<135 mmHg, 140 mmHg as the reference), two extremes of predialysis DBP (<55 and >95 mmHg, 90 mmHg as the reference), high levels of postdialysis SBP (>180 mmHg, 130 mmHg as the reference), and low levels of postdialysis DBP (<75 mmHg, 80 mmHg as the reference). Threshold effect was determined in the associations between peridialysis BP and all-cause mortality risk, and potential BP thresholds were identified (149 mmHg for predialysis SBP, 79 mmHg for predialysis DBP, 147 mmHg for postdialysis SBP and 76 mmHg for postdialysis DBP). In conclusion, the proposed peridialysis BP ranges and the threshold values could help clinicians identify high risk HD patients. The interpretation of the peridialysis BP mortality associations should be based on the features of HD population (especially the cardiovascular conditions, volume status and the dialysis vintage).
血压（BP）管理在血液透析（HD）人群中带来了巨大挑战。我们进行了一项剂量反应荟萃分析，以研究 HD 人群中透析间期 BP 水平与全因死亡率风险之间的定量特征和潜在阈值效应。我们检索了所有关于透析间期 BP 水平与全因死亡率风险之间关联的前瞻性队列研究（发表于 2017 年 3 月 18 日之前）。共有 8 项研究的 229688 例现患 HD 患者纳入研究。透析间期 BP 水平与全因死亡率风险之间存在显著的非线性关联。在四个透析间期 BP 范围内发现了死亡风险显著增加，即：透析前 SBP 水平较低（<135mmHg，以 140mmHg 为参照），透析前 DBP 两个极端值（<55mmHg 和 >95mmHg，以 90mmHg 为参照），透析后 SBP 水平较高（>180mmHg，以 130mmHg 为参照），以及透析后 DBP 水平较低（<75mmHg，以 80mmHg 为参照）。在透析间期 BP 与全因死亡率风险之间的关联中确定了阈值效应，并确定了潜在的 BP 阈值（149mmHg 为透析前 SBP，79mmHg 为透析前 DBP，147mmHg 为透析后 SBP，76mmHg 为透析后 DBP）。总之，提出的透析间期 BP 范围和阈值值有助于临床医生识别高危 HD 患者。对透析间期 BP 死亡率关联的解释应基于 HD 人群的特征（尤其是心血管状况、容量状态和透析龄）。
