Medical Science, Kawasaki Medical School, Okayama, Japan.
Tsuruta Itabashi Clinic, Tokyo, Japan.
Sci Rep. 2019 Mar 4;9(1):3362. doi: 10.1038/s41598-019-39908-6.
Because hypotension during hemodialysis (HD) makes continuation of HD difficult and is associated with mortality, pressor approaches are necessary for patients with hypotension. However, the relationships between the pressor approaches and the risk of death have not been clarified yet. We analyzed data from a nationwide prospective cohort study of the Japanese Society for Dialysis Therapy Renal Data Registry (n = 29,309). The outcome was all-cause one-year death. The association between the use of pressor approaches and the outcome was examined using Cox proportional hazards models adjusted for baseline characteristics, propensity score matched analysis and Bayesian networks. The background features of the patients were as follows: male, 59.6%; average age, 64.5 ± 12.5 years; and patients with diabetes mellitus, 31.5%. The pressor group showed a higher risk of the outcome than the control group [adjusted hazard ratio (aHR) 1.33 (95% CI: 1.21, 1.47), p = 0.0001]. Propensity score matched analysis also showed that the matched-pressor group had a higher risk of the outcome than the matched-control group [aHR 1.30 (95% CI: 1.17, 1.45), p = 0.0001]. Moreover, the Bayesian network showed a direct causal relationship from the use of pressor approaches to the outcome. The use of oral vasopressors [aHR 1.20 (95% CI: 1.07, 1.35), p = 0.0018], intravenous injection of vasopressors [aHR 1.54 (95% CI: 1.32, 1.79), p = 0.0001] and normal saline [aHR 1.18 (95% CI: 1.05, 1.33), p = 0.0066] were associated with a high risk of the outcome. In conclusion, this study showed that the use of pressor approaches during HD may be an independent risk factor for death.
由于血液透析（HD）期间的低血压会使 HD 难以继续进行，并与死亡率相关，因此需要使用升压方法来治疗低血压患者。然而，升压方法与死亡风险之间的关系尚未得到明确。我们分析了来自日本透析治疗学会肾脏数据注册中心（n=29309）的全国前瞻性队列研究的数据。主要结局为全因一年死亡。使用 Cox 比例风险模型，根据基线特征、倾向评分匹配分析和贝叶斯网络，调整了升压方法与结局之间的关联。患者的背景特征如下：男性占 59.6%；平均年龄 64.5±12.5 岁；糖尿病患者占 31.5%。升压组的结局风险高于对照组[校正风险比（aHR）1.33（95%可信区间：1.21，1.47），p=0.0001]。倾向评分匹配分析也表明，匹配升压组的结局风险高于匹配对照组[aHR 1.30（95%可信区间：1.17，1.45），p=0.0001]。此外，贝叶斯网络显示升压方法的使用与结局之间存在直接的因果关系。使用口服血管加压素[aHR 1.20（95%可信区间：1.07，1.35），p=0.0018]、静脉注射血管加压素[aHR 1.54（95%可信区间：1.32，1.79），p=0.0001]和生理盐水[aHR 1.18（95%可信区间：1.05，1.33），p=0.0066]与结局风险增加相关。总之，本研究表明，HD 期间使用升压方法可能是死亡的一个独立危险因素。
