Kim Ji Young, Seo Hye Mi, Kim Miyeon, Kim Hyunwoo
Division of Nephrology, Department of Internal Medicine, Jeju National University, School of Medicine, Jeju National University Hospital, Jeju-do, South Korea.
Hemodial Int. 2019 Apr;23(2):158-166. doi: 10.1111/hdi.12720. Epub 2019 Feb 7.
Vascular access dysfunction is a major cause of morbidity in patients with end-stage renal disease (ESRD) on hemodialysis (HD). Thus, identifying risk factors for vascular access failure is important. Patients on HD are routinely exposed to high blood pressure variability (BPV) during HD. However, the impact of intradialytic BPV on vascular access outcomes is unknown. Therefore, we investigated the association of intradialytic BPV with vascular access outcomes in patients on HD.
One hundred and thirty patients with ESRD who created vascular access for HD were evaluated. We examined 12 dialysis sessions per patient and recorded BP five times for each session. BPV was assessed using residual standard deviation derived from the linear regression model. The patients were divided into two groups according to a level below or above the median value of intradialytic BPV and compared. The primary outcome was primary unassisted vascular access patency.
The median time to loss of primary unassisted patency was significantly longer in low intradialytic BPV group than in high intradialytic BPV group (52 months vs. 21 months, P < 0.001) during the mean follow-up of 3.7 years. After adjustment for other variables, high intradialytic BPV was significantly associated with loss of primary unassisted vascular access patency (hazard ratio, 2.605; 95% confidence interval, 1.462-4.643; P = 0.001).
Our study revealed a significant correlation between intradialytic BPV and vascular access patency. Further studies are needed to identify methods for lowering BPV.
血管通路功能障碍是终末期肾病（ESRD）患者接受血液透析（HD）时发病的主要原因。因此，识别血管通路失败的风险因素很重要。接受HD治疗的患者在透析过程中经常暴露于高血压变异性（BPV）。然而，透析期间BPV对血管通路结局的影响尚不清楚。因此，我们研究了透析期间BPV与HD患者血管通路结局之间的关联。
对130例为进行HD而建立血管通路的ESRD患者进行评估。我们检查了每位患者12次透析疗程，每次疗程记录5次血压。使用线性回归模型得出的残差标准差评估BPV。根据透析期间BPV的中位数水平将患者分为两组并进行比较。主要结局是原发性非辅助血管通路通畅情况。
在平均3.7年的随访期间，低透析期间BPV组原发性非辅助通畅丧失的中位时间明显长于高透析期间BPV组（52个月对21个月，P<0.001）。在对其他变量进行调整后，高透析期间BPV与原发性非辅助血管通路通畅丧失显著相关（风险比，2.605；95%置信区间，1.462 - 4.643；P = 0.001）。
我们的研究揭示了透析期间BPV与血管通路通畅之间存在显著相关性。需要进一步研究以确定降低BPV的方法。
