Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan.
Department of Nephrology and Endocrinology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
BMC Nephrol. 2019 Dec 19;20(1):473. doi: 10.1186/s12882-019-1662-x.
Critical limb ischemia (CLI) and intradialytic hypotension (IDH) are common complications in patients on hemodialysis (HD). However, limited data are available on whether IDH is related to CLI in these patients. The aim of this retrospective study was to evaluate whether IDH is a risk factor for CLI in HD patients.
We examined the frequency of IDH in 147 patients who received HD between January 1 and June 30, 2012. Blood pressure was measured during HD every 30 min and IDH was defined as a ≥ 20 mmHg fall in systolic blood pressure compared to 30 min before and a nadir intradialytic systolic blood pressure < 90 mmHg. The primary study outcome was newly developed CLI requiring revascularization treatment or CLI-related death. We assessed the association of IDH with outcome using a multivariable subdistribution hazard model with adjustment for male, age, smoking and history of cardiovascular disease.
The median follow-up period was 24.5 months. Fifty patients (34%) had episodes of IDH in the study entry period. During follow-up, 14 patients received endovascular treatment and CLI-related death occurred in 1 patient. Factors associated with incident CLI in univariate analysis were age, smoking, diabetes mellitus, peripheral arterial disease, history of cardiovascular disease, and IDH. IDH was significantly associated with the outcome with the subdistribution hazard ratio of 3.13 [95% confidence interval, 1.05-9.37].
IDH was an independent risk factor for incident CLI in patients on HD.
在血液透析（HD）患者中，严重肢体缺血（CLI）和透析中低血压（IDH）是常见并发症。然而，关于 IDH 是否与这些患者的 CLI 相关，可用的数据有限。本回顾性研究旨在评估 IDH 是否是 HD 患者 CLI 的危险因素。
我们检查了 2012 年 1 月 1 日至 6 月 30 日期间接受 HD 的 147 名患者的 IDH 发生频率。在 HD 期间每 30 分钟测量一次血压，IDH 定义为与 30 分钟前相比收缩压下降≥20mmHg，且透析期间收缩压最低值<90mmHg。主要研究结局为新发生需要血运重建治疗的 CLI 或 CLI 相关死亡。我们使用多变量亚分布风险模型评估 IDH 与结局的相关性，调整因素包括男性、年龄、吸烟和心血管疾病史。
中位随访时间为 24.5 个月。50 名患者（34%）在研究入组期间出现 IDH 发作。随访期间，14 名患者接受了血管内治疗，1 名患者发生 CLI 相关死亡。单变量分析中与 CLI 事件相关的因素为年龄、吸烟、糖尿病、外周动脉疾病、心血管疾病史和 IDH。IDH 与结局显著相关，亚分布风险比为 3.13（95%置信区间，1.05-9.37）。
在 HD 患者中，IDH 是 CLI 发生的独立危险因素。
